William Purcell
Key learning points
- An FY2 rotation in ophthalmology provides transferable skills relevant across a wide range of specialties.
- Reading around common ophthalmic pathologies and applying this knowledge through focused history taking and examination is key, with emergency eye clinics offering valuable learning opportunities.
- Developing slit lamp examination skills is a beneficial and achievable goal during the rotation
Why an FY2 rotation in Ophthalmology is a great rotation
Ophthalmology is a highly specialised field yet eye related problems are commonly encountered across emergency departments and primary care (1). Many FY2 doctors begin a rotation with limited prior experience as undergraduate ophthalmology teaching and placements are often brief.
An FY2 rotation offers a unique opportunity to address this gap, it allows foundation doctors to develop focused history taking and clinical examination skills. This helps build confidence in managing both acute and chronic ophthalmic conditions. These skills are transferable across general practice, emergency medicine, and a range of medical and surgical specialties.
Understanding the Role of an FY2 in Ophthalmology
The role of an FY2 in ophthalmology varies between trusts. Generally, surgical opportunities will be limited compared to ophthalmology trainees within the department due to the level of experience required.
The role is largely based around assisting in general and emergency eye clinics, clerking patients for theatre, consenting and ensuring accurate documentation of procedures. FY2 doctors may also assist in theatre and undertake appropriate procedural skills under supervision.
Additional opportunities may include involvement in audit and quality improvement projects, as well as contributing to teaching within the department.
Building Confidence in Identifying and Managing Key Pathologies
Many of the conditions commonly encountered by ophthalmologists are also seen by non-ophthalmology doctors. Developing a good understanding of the presentation and management of key acute and chronic ophthalmic conditions is an achievable goal for the placement.
Reading around key conditions, particularly those that need to be ruled out, is a useful thing to do. High yield conditions for FY2 doctors include red eye presentations, corneal abrasions and foreign bodies, acute angle-closure glaucoma, anterior uveitis, retinal detachment and post-operative complications. Time in eye clinics can be used to take focused histories and practise examinations. Developing confidence in pupillary examination, including assessment for a relative afferent pupillary defect (RAPD), is a particularly valuable emergency skill.
The emphasis should be on identifying or excluding important clinical features. Asking seniors to talk through their thought process can help build clinical confidence and reasoning.
Developing Slit Lamp Examination Skills
An FY2 rotation is a great opportunity to build slit lamp examination skills which many doctors do not otherwise have the time to develop. Slit lamp examination can feel technically challenging at first, particularly posterior segment examination, but this should not be discouraging.
Regular practice is key, ophthalmologists become highly skilled because they perform slit lamp examination daily in clinics. At the start of clinics, ask which patients are dilated and whether there is an opportunity to practise examination with patient consent.
Under supervision, FY2 doctors can practise skills such as fluorescein application and corneal foreign body removal while learning to recognise important findings including swollen optic discs and retinal pathology. Letting clinicians know you are keen to be involved may lead to opportunities to see interesting findings.
References
- Rawlings A, Hobby AE, Ryan B, Carson-Stevens A, North R, Smith M, et al. The burden of acute eye conditions on different healthcare providers: a retrospective population-based study. British Journal of General Practice. 2024;74(741):e264-e74.