In the UK, ophthalmology is a highly competitive speciality, attracting many medical graduates keen to pursue a career in this area. However, in recent years, the competition ratios for ophthalmology ST1 training posts have increased significantly, creating a challenging environment for aspiring ophthalmologists.
This trend has prompted concerns regarding the availability of training opportunities and the quality of training received by those who are successful in securing a post. In this insert of our study, we looked at what this means for the future and the views of current medical students in light of the increased competition.
The main concerns regarding the increasing competition ratios include the limited availability of training posts, high demand for ophthalmology training, and a lack of diversity in the pool of applicants. Recent reports from Health Education England (HEE) suggest that the most recent cohort of applicants held a competition ratio of 8.97 [1], demonstrating that ophthalmology is a popular speciality, and the demand for training positions exacerbates the issue of limited availability.
Moreover, the dearth of diversity in the applicant pool stems from a complex interplay of factors. While it's true that the majority of applicants hail from prestigious universities, it's crucial to examine the underlying reasons. These universities, known for their rigorous academic programs, inadvertently contribute to the lack of diversity as they often cater to a specific demographic of students who can afford the associated costs and meet stringent admission criteria. This dynamic further exacerbates the competition for the limited ophthalmology training posts.
The link between the lack of diversity and the emphasis on academic background becomes even more pronounced upon closer examination. The criteria identified by Das et al [2] – attending world-renowned institutions such as Oxford, Cambridge and Imperial, completing the esteemed yet financially demanding FRCOphth Part 1 before application and achieving a competitive Educational Performance Measure (EPM) – collectively create a high barrier of entry. These criteria inherently favour candidates with access to resources, both educational and financial, which places applicants from lower economic backgrounds at a distinct disadvantage. As a result, these talented individuals face additional hurdles to meet the established criteria, contributing to the perpetuation of the lack of diversity in the applicant pool. These issues require attention and immediate solutions to ensure that ophthalmology continues attracting diverse applicants and that training opportunities are accessible to all qualified candidates. Taking note of these recent studies, we aimed to create a short survey directed at medical students, to identify if their views have altered following the release of this data, including how they view the specialty, and if their aspirations as aspiring ophthalmologists have changed with increasing competition ratios.
Methodology
Data collection
The data for this study was collected through an online survey via Google Forms. Before data collection, ethical considerations were taken into account. The survey was designed to fully anonymise the data, and consent was implied through the voluntary completion of the survey. Participants were informed about the study's purpose and the intended use of their data.
The survey questions were formulated based on previous medical career surveys, primarily drawing from the research conducted by Li et al in 2022 [3]. This ensured that the survey items were aligned with established methodologies and allowed for meaningful comparisons with previous studies.
The survey consisted of two main sections. The first section focused on gathering demographic information, including the participant’s university, year of study, gender, presence of family members who are doctors, previous exposure to ophthalmology, interest in ophthalmology as a career choice and any exposure or teaching related to ophthalmology during medical school.
The second section of the survey explored the student’s perspective on ophthalmology as a speciality. It included questions about lifestyle, prestige, variety of work, impact, training pathway and competition. All the survey questions used a five-point Likert scale, with response options ranging from one (strongly disagree) to five (strongly agree).
Data analysis
Once the survey responses were collected, the data was subjected to a quantitative analysis. Descriptive statistics, such as percentages and means, were used to summarise the participant's responses to each survey question. These statistical measures allowed for a clear presentation of the data and facilitated comparisons between different aspects of students' perspectives on ophthalmology.
Results
Survey response rate
Out of the 60 students who were invited to participate in the survey, 47 completed it, yielding a response rate of 78.3%.
Exposure and relevance
78.7% of the respondents believed that they had not received adequate exposure to ophthalmology during their medical school education. In addition, 74.4% of the participants felt that the teaching they had received in ophthalmology was not relevant to their clinical experience.
Opinions about ophthalmology
Despite the perceived limitations in exposure and relevance, opinions about the speciality itself were remarkably positive. A significant 74.4% of the respondents expressed that ophthalmology allowed for a good work-life balance. This perception reflects the potential attractiveness of the speciality in terms of career satisfaction and personal well-being.
Furthermore, 76.6% of the participants believed that ophthalmology offered a better lifestyle compared to other medical specialities. This finding highlights the perceived advantages associated with pursuing a career in ophthalmology and may contribute to the speciality's popularity among medical students.
Training pathway satisfaction
93.3% of the surveyed students expressed dissatisfaction with the current training pathway in ophthalmology. This finding underscores the importance of evaluating and refining the educational framework to better meet the needs and expectations of aspiring ophthalmologists. Addressing these concerns can contribute to a more fulfilling and effective training experience.
Impact of competition ratios
As mentioned before, competition ratios in medical specialities can influence students' career decisions. Interestingly, 63.8% of the respondents reported that the increased competition ratios in ophthalmology have not dissuaded them from applying to the speciality. This suggests that the increased level of competition is not discouraging some students from pursuing ophthalmology as their career choice.
Discussion
Amidst the array of challenges, the unwavering interest in ophthalmology as a speciality serves as a testament to its enduring allure for medical graduates. This enduring appeal holds promising implications for the profession's future, particularly in the context of diversity. A robust and diverse applicant pool reinforces the profession's vitality and underscores its capacity to attract the most exceptional and promising medical graduates. By fostering inclusivity, the field ensures that a wide spectrum of talents, perspectives and backgrounds converge in ophthalmology. Consequently, as these diverse minds converge, they infuse the field with fresh insights, novel skills and innovative viewpoints, invigorating it with an enriched dynamism that propels both equity and excellence.
“Steps should be taken to promote diversity in the pool of applicants. This will help ensure that the profession reflects the communities it serves and continues to evolve in response to changing patient needs.”
One possible explanation for this sustained interest in ophthalmology is the high level of job satisfaction reported by ophthalmologists. Sabbaghi et al [4] found that 88.1% of ophthalmologists surveyed reported high satisfaction with their role, interestingly more so in those who had been practising for a longer duration. Ophthalmology is a field that allows for a high degree of independence and autonomy, and ophthalmologists often form long-term relationships with their patients, providing a sense of continuity and fulfilment. Similarly, there is a rise in exciting technological advancements that are transforming the field; the use of AI in ophthalmology is just one example of cutting-edge technology being developed to improve diagnosis and treatment outcomes [5] and a contributing factor to a highly-sought-after speciality.
Our study findings further confirm the prevailing inadequacy of exposure to ophthalmology as a specialised field within medical schools in the UK. This corroborates earlier research conducted by Baylis, Murray and Dayan [6], who identified that 21% of medical schools did not include ophthalmology as a mandatory clinical attachment, and those that did provide a mere average of seven days for students to acquaint themselves with this speciality. These outcomes underscore the urgent need for concerted efforts aimed at facilitating more enriching experiences for students, enabling them to make well-informed career decisions about ophthalmology.
This can be further observed beyond medical school and in ophthalmology training programs, particularly in the perspectives of specialty trainees. Notably, a survey conducted by Dean et al [7] revealed that 34.4% of trainee ophthalmologists expressed the belief that the training program should be shortened from its current duration of seven years. Furthermore, 45.2% of respondents felt that their work contracts did not accurately reflect their actual working hours. These findings highlight significant areas for improvement within the UK-based training program. Further efforts must be directed towards enhancing the training experience for all trainee ophthalmologists, addressing concerns such as program duration and aligning work contracts with actual working hours.
Similarly, ensuring that the selection process for these training posts is fair and equitable is essential so that all qualified candidates have an equal opportunity to succeed. Additionally, steps should be taken to promote diversity in the pool of applicants. This will help ensure that the profession reflects the communities it serves and continues to evolve in response to changing patient needs.
It is important to acknowledge certain limitations of this study. Firstly, the survey sample was limited to a specific cohort of students who had the forms sent out to them, which may not be representative of the entire student population. Secondly, the reliance on self-reported data introduces the possibility of response bias. Lastly, as the study focused on students' perspectives at a particular point in time, longitudinal follow-up could provide further insights into medical students' evolving views and experiences in ophthalmology.
Conclusion
This study shows that despite the mixed experiences of ophthalmology amongst UK-based medical students, ophthalmology continues to be an attractive speciality. This is despite competition ratios steadily increasing year on year, which can be accredited to job satisfaction, high patient impact, work-life balance and the distinguished role of ophthalmologists that medical students still view. Steps must be taken to ensure increased exposure and training opportunities in ophthalmology. By doing so, students can gain more valuable insights into the speciality to make informed career choices and contribute to its growth and advancement within the UK healthcare system. This, alongside addressing the rising competition ratios in ophthalmology, emphasises the urgency of increasing training numbers to effectively meet the escalating demand for skilled ophthalmologists.
References
1. Health Education England. Competition ratios for 2022.
https://medical.hee.nhs.uk/medical-training
-recruitment/medical-specialty-training/
competition-ratios/2022-competition-ratios
2. Das A, Smith D, Mathew RG. Predictors of ophthalmology career success (POCS) study. BMJ Open Ophthalmol 2021;6(1):e000735.
3. Li B, Michaelov E, Waterman R, Sharan S. Ophthalmology as a career choice among medical students: A survey of students at a Canadian Medical School. BMC Med Educ 2022;22(1):225.
4. Sabbaghi H, Kalantarion M, Yaseri M, et al. Job satisfaction among ophthalmologists in Iran. J Ophthalmic Vis Res 2022;17(4):543-550.
5. Baylis O, Murray PI, Dayan M. Undergraduate Ophthalmology Education – A survey of UK medical schools. Med Teach 2011;33(6):468-71.
6. Anton N, Doroftei B, Curteanu S, et al. Comprehensive review on the use of Artificial Intelligence in Ophthalmology and Future Research Directions. Diagnostics (Basel) 2022;13(1):100.
7. Dean WH, Grant S, McHugh J, et al. Ophthalmology specialist trainee survey in the United Kingdom. Eye (Lond) 2019;33(6):917-924.
Declaration of competing interests: None declared.
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