Prague, Czech Republic Prague, , Prague, Czech Republic Teaching Hospital, Prague, Czech Republic [email protected] Financial disclosure: None Ophthalmology Department, Vinohrady [email protected] Financial disclosure: None Ophthalmology Department, Vinohrady Teaching Ophthalmology Department, Vinohrady Teaching     PAVEL KUCHYNKA, CSC, FCMA CSC, KUCHYNKA, PAVEL DELI KRIZOVA, FEBO KRIZOVA, DELI n n n n n site in a relatively small field such as ophthalmology injects differences into the conditions and organization of the examinations, which can confuse young doctors. n DELI KRIZOVA, FEBO, AND AND FEBO, KRIZOVA, DELI PAVEL KUCHYNKA, CSC, FCMA CSC, KUCHYNKA, PAVEL

The country’s educational system The system’s main drawback is the medical faculties at six institutions. Periodic rotation of the examination program, is free of charge for students. Moreover, the residency program is revised every 2 to 3 years to reflect evolutions in medicine. organization of attestation examinations. In the past, these examinations were organized by the Institute for Postgraduate Medical Education, which falls under the Ministry of Health. In 2012, the examinations were transferred to the Ministry of Education, and now their organization is handled by the institution of the faculty. Fellowships are offered by individual clinics or organized centrally by the Institute for Postgraduate Medical Education. CONS AND PROS works well as a whole. A major positive is that most of the education, including medical school and the residency -

| JANUARY/FEBRUARY 2021 JANUARY/FEBRUARY | edical training in the Czech Republic lasts 6 years. At the end of training, students must complete rigorous state examinations to obtain the

To complete the program, residents Ophthalmology residency is divided ophthalmological training followed by examinations and 2 years of specialized training followed by attestation exami nations—a total of 4.5 years. Attestations are organized by medical faculty twice a year; the venue depends on the Residency training takes place at workplaces that are accredited for specialized education in ophthalmology and other clinical fields. must complete 2.5 years of basic graduate may seek employment in any clinical field of medicine. SPECIFICS TRAINING into two parts: basic ophthalmologic training and specialized training. title of general doctor (MUDr). A recent Medical School and Residency: Medical School and Residency: Free of Charge for Students BY DELI KRIZOVA, FEBO; PAVEL KUCHYNKA, CSC, FCMA; WANJIKU MATHENGE, MBCHB, MMED, MSC, PHD; PHD; MSC, MMED, MBCHB, MATHENGE, WANJIKU FCMA; CSC, KUCHYNKA, PAVEL FEBO; KRIZOVA, DELI BY FEBO; MRCSED, FRCOPHTH, MD, PHD, SCOTT, ANDREW FRCOPHTH; BSC(HONS), MBBS, RAMPAT, RADHIKA MD VINCIGUERRA, RICCARDO AND PHD; MD, VALDEZ-GARCÍA, E. JORGE An overview of similarities and differences in systems far and wide. far and wide. and differences in systems An overview of similarities RESIDENCY, AND FELLOWSHIP AND RESIDENCY, AROUND THE WORLD: WORLD: THE AROUND TRAINING, MEDICAL M GLAUCOMA TODAY GLAUCOMA 38 s PERSPECTIVES GLOBAL GLOBAL PERSPECTIVES s MEDICAL TRAINING AND OPHTHALMOLOGY RESIDENCY AND FELLOWSHIP PROGRAMS Transformations in Training Modules

he goal of undergraduate and Rwanda, three private universities graduate medical training in have opened medical schools, but Rwanda is to produce general they have yet to graduate any doc- WANJIKU MATHENGE, doctors and specialists with tors. The pool of doctors to recruit MBCHB, MMED, MSC, PHD competencies and skills that meet into ophthalmology residency training Tpatients’ reasonable expectations. remains limited. Kigali, Rwanda The University of Rwanda is the Ophthalmology residency training country’s oldest medical school. It is the only specialty hosted not by admits students who have completed the University of Rwanda but by the 12 years of formal education, rank at Rwanda International Institute of the top of the cohort, and have passed Ophthalmology (RIIO), a constituent the Advanced General Certificate of training program of the College of Secondary Education. The university’s Ophthalmology of Eastern Central enforcement of the college training training program requires 5 to 6 years and Southern Africa (COECSA). standards have been possible at new to complete and culminates with the This program admits doctors from institutions like the RIIO, but the awarding of a bachelor’s degree in Rwanda, Burundi, and Congo, and it transition is happening more slowly medicine and surgery with honors. awards a fellowship in ophthalmology at older institutions with Master of The University of Rwanda also offers after a minimum of 4 years of train- Medicine in ophthalmology training nine programs that confer a Master ing. This college-based training is programs that are governed under of Medicine to doctors who have becoming more popular. The empha- institutional frameworks that existed performed 2 years of public service sis is on equipping every graduate before COECSA.2 For example, as general doctors; most of these are with defined core competencies, training lasts 3 years in some programs 4-year programs. including all of the requisite knowl- and 4 years in others. A goal of the In order to address a massive edge, technical skills (Figure 1), and COECSA is to develop its own written shortage in medical doctors in soft skills (eg, communication, ethics, examinations and either to slowly patient safety, and professionalism) replace the ICO examinations or to that are deemed to be essential in the have a blend of both. medical profession. The first cohort of ophthalmology The program draws on the best residents at the RIIO are on track to practices of the UK’s Royal College of complete their training by mid-2022. Ophthalmology1 and the International Once they begin practicing in hospi- Council of Ophthalmology (ICO). tals, the quality of their services will Trainees at the RIIO must pass the give a true indication of the value of ICO’s examinations in visual sciences, this training model. optics and refraction, and instruments 1. Corbett MC, Mathenge W, Zondervan M, Astbury N. Cascading training the Courtesy of Wanjiku Mathenge, MBChB, MMed, MSc, PhD as well as in clinical sciences before trainers in ophthalmology across Eastern, Central and Southern Africa. Global Health. 2017;13(1):46. presenting for a clinical examination 2. Dean W, Gichuhi S, Buchan J, et al. Survey of ophthalmologists-in-training in Eastern, Central and Southern Africa: A regional focus on ophthalmic surgical offered by the COECSA. Candidates education. Wellcome Open Res. 2019;4:187. must show that they have achieved all of the COECSA residency training milestones and charted their progress WANJIKU MATHENGE, MBCHB, MMED, MSC, PHD during clinical placements using n Director of Training and Research, Rwanda workplace-based assessments. International Institute of Ophthalmology, Kigali Figure 1. RIIO trainees use surgical simulation training for COECSA has members from n [email protected] cataract surgery. 12 African countries. Adoption and n Financial disclosure: None

JANUARY/FEBRUARY 2021 | GLAUCOMA TODAY 39 Figures 2–4 courtesy of Radhika Rampat, MBBS, BSc(Hons), FRCOphth, and Andrew Scott, PhD, MD, FRCOphth, MRCSEd, FEBO London, London,

FRCOPHTH, FRCOPHTH, SCOTT, PHD, PHD, SCOTT, AND ANDREW ANDREW AND United Kingdom MRCSED, FEBO MRCSED, MD, FRCOPHTH, FRCOPHTH, MD, MBBS, BSC(HONS), BSC(HONS), MBBS, RADHIKA RAMPAT, RAMPAT, RADHIKA ). Seven KeySeven Moreover, the length of the program Only through high-quality trainingOnly through high-quality voiced aboutA complaint sometimes International Federation of Medical Students Associations; MEGA, Moorfields Emergency Guidelines App EH, ; IFMSA, Abbreviations: ST, specialist trainee; UCH, University College Hospital; RFH, Royal Free Hospital; WEH, Western Eye Hospital; MEH, Moorfields Eye Hospital; IFMSA, too long, but it is the only one in Europetoo long, but it is the year ofthat incorporates a mandatory fellowship in a specific specialty of choice. helps to ensure a depth and breadth hospital if the training standards arethe training standards hospital if not met. of care forcan the highest standard (see patients be ensured Training for Goals Recommended TIME is that it isthe UK’s training program Figure 3. Dr. Rampat’s journey from medical school to present, as she embarks on consultant applications and completes completes and applications consultant on embarks she as present, to school medical from journey Rampat’s Dr. 3. Figure fellowship. second her OOPE, out-of-program experience; trainee; TSC, trainee-selected component; OOPE, out-of-program experience; Abbreviations: GP, general practitioner; GMC, General Medical Council; ST, specialist OOPT, out-of-program training; OOPR, out-of-program research (eg, PhD, MD). Kingdom. United the in training of summary A 2. Figure -

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fter 4 to 6 years in medicalfter 4 to 6 Kingdom,school in the United astudents graduate with bachelor of medicine/bachelor of surgery (MBBS) degree

The United Kingdom’s structured Specialty training occurs within Selection into ophthalmology Deanery, there is an incentive for NHS to provide a high standard of training in order to retain their trainees. individuals provide invaluableThese work to support the NHS, and the Deanery may remove them from a QUALITY QUALITY training programs are held in high regard internationally and attract participants from overseas. Because salaries for training doctors are partly funded by the governance plays a major role in UK training; participants are not only taught about it but must also submit evidence of practicing it. Figures 3 and 4 show our specific training journeys. National Health Service (NHS) hospitals, but it is the Deanery and Royal College of Ophthalmologists that ensures standards and quality of training are upheld. Clinical Progression, and participants must complete three tough examinations that include a refraction certificate and two Fellowship of the Royal College of Ophthalmologists examinations (FRCOphth parts 1 and 2). by incorporating research into their training program or other degrees prior to application to an ophthalmology training program in order to improve their chances of selection. Each of the 7 years of training includes a rigor ous Annual Review of Competence by completing another 2 years ofby completing another (Figure 2).foundation training is highlyprograms in our country may choosecompetitive. Participants to pursue either an academic route with or without a bachelor of sciencewith or without a bachelor is achieveddegree. Full registration Using Seven Key Recommended Goals for Training Key Recommended Using Seven A GLAUCOMA TODAY GLAUCOMA 40 s PERSPECTIVES GLOBAL

Mexico Monterrey, Monterrey, JORGE E. E. JORGE MD, PHD MD, VALDEZ-GARCÍA, VALDEZ-GARCÍA, Established structure Standardized curriculum Adequate supervision Regular appraisals and assessments Surgical logbook evidence Portfolio of training evidence Formal fellowships and appraisals       

SEVEN KEY KEY SEVEN GOALS RECOMMENDED FOR TRAINING s s s s s s s NHS Trust, London NHS Trust, London Cornea fellow and Administrative Lead, Moorfields Eye Hospital Hospital Cornea fellow and Administrative Lead, Moorfields Eye Hospital, Paris Honorary cornea research fellow, Rothschild Foundation [email protected] Financial disclosure: None Eye Hospital Consultant Ophthalmic Surgeon, Glaucoma Service, Moorfields [email protected] Financial disclosure: None      RADHIKA RAMPAT, MBBS, BSC(HONS), FRCOPHTH BSC(HONS), MBBS, RAMPAT, RADHIKA FEBO MRCSED, FRCOPHTH, MD, PHD, SCOTT, ANDREW n n n n n n n Training programs are Access. There are 13 academic residency concentrated in a few cities; the cities Medical Residence System of the Interinstitutional Commission for the Training of Human Resources in Health. OPPORTUNITIES TRAINING programs in ophthalmology endorsed by universities that operate in 28 clinical training sites (hospitals), and the National Autonomous University of Mexico endorses 46% (n = 13) of these training sites.

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physicians-in-training become competent to practice in their field of medicine. Training in he goal of graduate medical education is to ensure that In Mexico, medical residency is A possible change to the system would be to reduce generalA possible change to the system would be Board of Ophthalmology; FRCOphth, Council, GMC; FEBO, Fellow of the European Board of Ophthalmology; FRCOphth, Abbreviations: PLAB, Professional and Linguistic Assessments Board; General Medical of Surgeons Edinburgh; UCL, University College London; ST, specialist trainee; SOE, Fellow of the Royal College of Ophthalmologists; MRCSEd, Member of the Royal College European Society of Ophthalmology Figure 4. Dr. Scott’s journey from medical school to his current glaucoma specialization at Moorfields Eye Hospital. Eye Moorfields at specialization glaucoma current his to school medical from journey Scott’s Dr. 4. Figure defined as a set of academic, care, and research activities that are endorsed by universities and the operative programs implemented by the clinical training sites. Each residency program must be registered with the National ophthalmology residency programs is highly competitive. Integrating Competency-Based Care Into Residency Programs Integrating Competency-Based Care Into Residency training time and increase fellowship time. Efforts could also betraining time and increase fellowship time. dedicated trainers.made to develop fewer but higher-qualified, ophthalmologistsAdditionally, the number of trained medical burden of visioncould be expanded to help manage a growing loss that does not require surgical intervention. emotional, analytical, and creative intelligence that supportsemotional, analytical, and creative intelligence ability whentheir surgical independence and decision-making of Training and startthey receive a Certificate of Completion applying for jobs as a consultant. IMPROVEMENTS POSSIBLE of experience. For instance, participants are not only taughtof experience. For instance, participants are practice withtechnical skills but also how to approach T GLAUCOMA TODAY GLAUCOMA 42 s PERSPECTIVES GLOBAL GLOBAL PERSPECTIVES s

with the highest concentration are Monterrey, has an innovative competence level (Tecnológico de Mexico City (46%), Monterrey (14%), public-private (nonprofit) approach. Monterrey), three with a consolidated and Guadalajara (11%). Geographically, Certification. After completing a level, and six with a development level. of the 32 states that make up 3- to 4-year training period (only three the Mexican Republic, only programs require 4 years to complete), CONCLUSION 30% (n = 10) have a residency program residents graduate with a university Competency-based medical education in ophthalmology. degree of specialist in ophthalmology. is gaining strength as a solution to the In order to obtain a spot in a To practice ophthalmology, graduates challenges of the modern era. The goal residency program, the graduate must obtain a cedula professional is to develop Mexico’s ophthalmology physician must pass the highly license, which requires passing the residency programs to provide this type selective National Examination Mexican Board of Ophthalmology of education. of Medical Residency Applicants. certification examination. This is a Candidates compete for 292 spots practical and theoretical examination. (271 for Mexicans and 21 for Accreditation. Excellence in clinical JORGE E. VALDEZ-GARCÍA, MD, PHD foreigners) in the different academic care demands quality medical n Dean of the School of Medicine and Health programs. The largest number of education. This principle has Sciences, Tecnológico de Monterrey, Mexico training opportunities (115 or 42%) prompted initiatives for evaluation and n Senior Scholar, Mexican Academy of Surgery are located in the clinical facilities accreditation in Mexico’s residency n Founding member, National Academy of of the Mexican Institute of Social programs. The National Council of Medical Education Security. Another 54 slots (19%) Science and Technology established n Chair, Pan American Ophthalmology Foundation are available from the Ministry of an accreditation system for medical n President-Elect, Mexican Association of Faculties Health. Approximately 20% of training residencies, the List of the National and Schools of Medicine opportunities are available through Graduate Quality Program. Only n Former president, Mexican Society of Ophthalmology five nongovernmental organizations; 10 (35%) clinical training sites are n [email protected] one of them, Tecnológico de accredited—one with an international n Financial disclosure: None

Ophthalmology Fellowships Found Abroad RICCARDO VINCIGUERRA, phthalmology residency in Italy in areas like cornea, glaucoma, and MD is not only medical but surgical vitreoretinal surgery. How else are as well. In some ways, this you to truly prepare for all of the Milan, Italy design provides those of us who procedures required in anterior and completed residencies in Italy posterior segment surgery? How Owith an advantage over those who else can you experience full-on what completed residencies in countries you’re going to do for the rest of that do not include surgical rotations. your life? The problem in Italy is that not every resident gets the same type of surgical LOOKING ABROAD experience and that some do not In Italy and many other European get any surgical experience at all. It is countries, there are no real fellowship highly dependent on the program and programs, so those who are interested to perform complex surgeries. It also the faculty. in pursuing one look abroad. One helped me to decide to pursue corneal After completing a 4-year popular fellowship destination is the surgery as a specialty. ophthalmology residency in Italy, the United Kingdom. I completed two Another benefit to looking abroad next logical step, I believe, is fellowship. fellowships, one glaucoma and one for fellowship is that it exposes you to Fellowships are not mandatory, but to cornea, in Liverpool. Both fellowships other cultures, other languages, other my mind, they should be—especially took place at referral centers, which people, and other landscapes. It helps for individuals who want to specialize provided me with the opportunity you to grow, not only as a doctor, but

JANUARY/FEBRUARY 2021 | GLAUCOMA TODAY 43 - n YoungMD Connect features YoungMD Connect features n

Small group mentoring sessions and private Small group mentoring sessions and private Educational and networking events organized by YoungMD Educational and networking events organized by YoungMD Mentoring sessions. Mentoring by YoungMD office hours with ophthalmic thought leaders, facilitated learn from and Connect, offer members the unique opportunity to network with a variety of esteemed mentors. fellowships. academic and practice Private an interactive map of US- and Canada-based ophthalmology private practice and academic fellowship programs. Members can explore a range of fellowship opportunities and utilize YoungMD Connect to determine their best fit. Events. Connect are designed to help members establish and maintain connections with ophthalmic colleagues and industry members.   

s s s To learn more about YoungMD Connect, visit www.youngmdconnect.com or follow @YoungMDConnect on Twitter and Instagram. Hospital-based fellowships have advantages and disad Hospital-based fellowships of many of the rising If you look at the credentials San Pio X Hospital, Milan, Italy Department of Ophthalmology, Humanitas Department of Ophthalmology, Humanitas [email protected] Financial disclosure: None   RICCARDO VINCIGUERRA, MD VINCIGUERRA, RICCARDO n n n Fellowships are not in mainstream practice in most of practice in most are not in mainstream Fellowships hospitals. are in large many of those available Europe, and States, for instance, from in the United This is different practices offer specialized fellowships. where many private hand, they expose you to a variety of vantages. On the one it can take much longer to learn surgeries. On the other, a limited amount of technology. things, and there is in Europe, you will notice that stars in ophthalmology done a fellowship abroad—usually most of them have or in the United Kingdom. I think in the United States unmet need in Europe for more that there is a large and it is something that we as a fellowship opportunities, Union should think about improving. . YoungMD Connect’s educational workshops . YoungMD Connect’s educational workshops | JANUARY/FEBRUARY 2021 JANUARY/FEBRUARY |

Educational workshops Educational will help aspiring and young ophthalmologists to navigate the nuances of skills training, innovations in ophthalmology, business management, advances in patient care, and more.  YoungMD Connect (Bryn Mawr Communications) is a membership-based YoungMD Connect (Bryn Mawr Communications) is a membership-based Ophthalmology training and early career development are complex are complex Ophthalmology training and early career development s informed decisions about the future of their careers. A variety of tools and informed decisions about the future of their careers. A variety of tools and functions are available to YoungMD Connect members, as outlined below. experiences. In an effort to help individuals seeking additional guidance additional guidance experiences. In an effort to help individuals seeking and support in their training and career pursuits, a new resource for aspiring and young ophthalmologists has entered the scene. online platform designed to help aspiring and young ophthalmologists establish meaningful connections, advance their training, and make A new resource for aspiring and young ophthalmologists in the United States and Canada. A new resource for aspiring and young ophthalmologists ongoing COVID-19 phases of every ophthalmologist’s journey, and the to these pandemic has introduced added challenges and uncertainties INTRODUCING: YOUNGMD CONNECT INTRODUCING: YOUNGMD In many cases, including mine, fellowships are found In many cases, including

are living (Figure 5). are living EXPANSION FOR NEED word-of-mouth recommendations. through referrals or also as a human, through the experiences you share with experiences you share through the also as a human, which you of the country in and other residents colleagues Figure 5. Dr. Vinciguerra (left) with his former fellows Esmaeil Arbabi, MD, MD, Arbabi, Esmaeil fellows former his with (left) Vinciguerra Dr. 5. Figure MD. Tzamalis, Argyrios and Courtesy of Riccardo Vinciguerra, MD Vinciguerra, Riccardo of Courtesy GLAUCOMA TODAY GLAUCOMA 44 s PERSPECTIVES GLOBAL