Dear Editor,We read with interest the article by Thomas et al.1 They
highlighted an important issue in their article on standards of
ophthalmic education in the country.1 What is shocking is the
absence of any significant improvements over an eight-year
period. This would suggest that improvements in infrastructure
alone are inadequate to address this problem.In the accompanying editorial Grover recommends setting
up an advisory board.2 A smaller body comprising persons who
have run programs that have actually achieved the benchmarks
recommended for education would be a better option, instead
of a monolithic body comprising ″ex-officio″ members who do
not necessarily have a track record in education.There is no question that state-of-the-art ophthalmic
care is available in both the private and public sector in the
country. In such a setting are we justified in claiming to have
provided appropriate ophthalmic training for residents who
have been allowed to perform less than 10 cases of cataract
surgery in their three-year courses? Perhaps the most telling
commentary on training in the country are the various courses
that offer to teach slit-lamp examination, gonioscopy or indirect
ophthalmoscopy to those who have completed postgraduate
training !! A certain proportion of ophthalmology graduates
make the effort to upgrade their skills. Those who are unable
to do so because of financial or other constraints are unlikely
to provide appropriate standards of care to their patients both
to start with, and for the three to four-decade duration of their
professional career.The postgraduate practical examination system is pointless
in the current form. Having gone through examinations
conducted by various agencies within the past decades I
can attest to the fact that it is purely theory-based. The term
″practical″ examination seems to have lost its meaning. What
matters are how many causes or differential diagnosis you
can recall and not how the patient was examined. This is far
removed from the medical and surgical practical examination
at the undergraduate level where more often than not, one
is asked to demonstrate an examination technique or test at
the bedside. In addition, the quality of equipment provided
at some recognized examination centers is unacceptable for
patient evaluation, let alone an examination.Many residents trained at the better residency programs in
the country are actually penalized because ″you know only the
high-tech stuff and cannot spout the examiners favorite lines
from the older edition of an undergraduate textbook.″ Perhaps
part of the reasons for this is lack of familiarity. Do we need to
initiate certification for examiners to ensure that basic levels of
competence are met, instead of continuing to rely on ″senior″
examiners (whose basic training may never have reached the
prescribed standards)?