Hammaad Khalid

Outpatient clinics are a major part of ophthalmology training. They are where trainees develop many of the skills needed for independent practice, including history-taking, examination, interpretation of investigations, clinical reasoning, decision-making and communication with patients. The Royal College of Ophthalmologists’ OST Curriculum 2024 places emphasis on broad clinical and professional capabilities, including patient management across ophthalmic subspecialties (1). Similarly, the medical ophthalmology curriculum describes clinic-based learning as an opportunity for supervised assessment, increasing responsibility and feedback from senior clinicians (2). In practice, however, busy outpatient services can make it difficult to balance service delivery with meaningful trainee-led consultations.

During a recent clinical placement in rheumatology, I observed a clinic model that seemed particularly effective from an educational perspective. Patients were booked under a consultant-led service rather than being allocated to individual trainee lists. A group of specialty registrars reviewed patients from a shared clinic pool, while two supervising consultants remained available in a central room. Each trainee selected a patient, undertook the consultation, performed the relevant examination, reviewed investigations and formulated an initial management plan. The case was then discussed with a supervising consultant, who reviewed the patient where needed, confirmed or refined the assessment, and supported the final management decision.

What stood out was how naturally the structure created learning opportunities. Trainees were not simply observing consultant decision-making or presenting after a brief review. They were acting as the first clinician, taking ownership of the consultation and then receiving immediate senior input. This appeared to support experiential learning, where clinical experience is followed by reflection and then applied to future practice (3). The learning was therefore embedded within the work of the clinic, rather than being separate from it.

This type of model could be relevant to ophthalmology. A supervised pooled clinic could allow ophthalmology trainees to review patients from a shared consultant-led list, assess the patient, interpret relevant investigations such as optical coherence tomography scans or visual fields, and propose an initial management plan. The supervising consultant could then review the patient when clinically appropriate, confirm the plan and provide focused feedback. This may be particularly useful in medical retina, glaucoma, uveitis, neuro-ophthalmology or general ophthalmology clinics, where clinical reasoning and investigation interpretation are central to patient management.

The educational value of such a model lies in the balance between autonomy and supervision. Trainees need enough independence to develop confidence and judgement, but patients must remain under safe consultant oversight. This balance has already been discussed in ophthalmology education literature, with supervision and autonomy recognised as important but sometimes difficult to balance in outpatient training (4). A pooled supervised clinic may offer a practical middle ground: trainees lead the initial assessment, but consultants remain immediately available to guide decision-making and ensure patient safety.

Feedback is another important benefit. Ende described feedback in clinical education as information about a learner’s performance that is intended to guide future performance (5). In busy clinics, feedback can easily become brief, delayed or missed altogether. In the model observed, feedback was immediate because the trainee discussed the case straight after assessing the patient. This made the feedback specific, relevant and directly linked to the trainee’s own clinical reasoning. For ophthalmology trainees, this could be especially valuable when interpreting imaging, deciding on follow-up intervals, considering treatment escalation or communicating risk to patients.

There would, of course, be practical considerations before applying this model in ophthalmology. Patient selection would need to be appropriate, with complex or unstable cases identified early for direct consultant review. The number of trainees per consultant would need to be realistic, and clinic templates would need enough flexibility to allow discussion without compromising patient flow. Documentation responsibilities should also be clear. This model may not suit every clinic, particularly where procedural workload or patient complexity is high. However, it could be piloted in selected outpatient settings as a structured educational intervention.

Ophthalmology training already has a strong apprenticeship-based culture, but increasing outpatient demand can limit opportunities for trainees to lead consultations with immediate senior feedback. A shared-list, consultant-supervised clinic model may provide a simple and practical way to increase trainee autonomy, strengthen clinical reasoning and improve feedback while maintaining patient safety. Further evaluation through trainee feedback, consultant feedback and service impact measures would help determine whether this model could be usefully adapted within ophthalmology outpatient training.

References

1. Royal College of Ophthalmologists. OST Curriculum 2024 (Internet). London: Royal College of Ophthalmologists; 2024 (cited 2026 Jun 13). Available from: https://www.rcophth.ac.uk/training/ophthalmic-specialist-training/curriculum-documents/
2. General Medical Council. Curriculum for Medical Ophthalmology Training (Internet). London: General Medical Council; 2021 (cited 2026 Jun 13). Available from: https://www.gmc-uk.org/cdn/documents/medical-ophthalmology-2021-curriculum-final_pdf-86496286.pdf
3. Kolb DA. Experiential learning: experience as the source of learning and development. Englewood Cliffs, NJ: Prentice-Hall; 1984.
4. Singman EL, Boland MV, Tian J, Green LK, Srikumaran D, Writing Committee of the Ophthalmology Program Directors’ Study Group. Supervision and autonomy of ophthalmology residents in the outpatient clinic in the United States II: a survey of senior residents. BMC Med Educ. 2019;19:202. doi:10.1186/s12909-019-1620-0.
5. Ende J. Feedback in clinical medical education. JAMA. 1983;250(6):777-81. doi:10.1001/jama.1983.03340060055026.