Advanced Sub-Specialty Training Opportunities ('Trainee Selected Components' from August 2007 - see below)
ASTOs in ophthalmology aim to provide in-depth sub-specialty training for UK trainees who have entered Higher Specialist Training (HST ie Specialist Registrar grade) in ophthalmology. They are usually 6 or 12 months in duration and they are normally taken during Year 4 or 5 of the HST Programme.
ASTOs are primarily available only to trainees in HST posts in the UK, in contrast to 'Fellowships' (see below) which are available to any suitably qualified ophthalmologist from any country. Some sub-specialty training posts previously designated 'Fellowships' have converted to ASTOs. If an ASTO cannot be filled by a UK trainee it may become available as a standard Fellowship open to any applicant. The situation throughout the UK is currently in a state of flux.
ASTOs may be taken in Oculoplastic and Adnexal Surgery (including lacrimal); Cornea and External Diseases; Cataract and Refractive Surgery; Glaucoma; Retina, Vitreous and Uvea (including intraocular tumour); Neuro-ophthalmology (including eye movement disorders); Paediatric Ophthalmology and Strabismus.
All Regional Training Programmes should provide ASTOs to cater for their own trainees but few Regions have a full quota of ASTOs in place. Trainees may apply to train in an ASTO elsewhere, including overseas (usually a 'Fellowship', but recognised as an ASTO), although at present most ASTOs/Fellowships abroad are not yet recognised by the Training Committee of the Royal College of Ophthalmologists for training and therefore cannot count towards the Certificate of Completion of Specialist Training (CCST).
ASTOs in the UK must be funded through the Medical and Dental Educational Levy (MADEL) in order to be recognised by the Royal College of Ophthalmologists. This requirement of EEC law does not apply to ASTOs outside the EEC so some unfunded overseas ASTOs/Fellowships will be recognised by the College and count towards the CCST.
After August 2007
With the introduction of 'Modernising Medical Careers' in the UK fundamental changes to training will occur from August 2007 - pilots have been run in some centres from August 2006. 'Run through' training - previously Higher Surgical Training (HST) - will complete a 7 year training in ophthalmology. Trainees who are making satisfactory progress will be expected to undertake more focussed training in a choice of specialised areas of ophthalmology - the 'Trainee Selected Component' (TSC) - of which 'Oculoplastics, Lacrimal and Orbital Diseases' is one. This will normally be taken towards the end of training and will last up to year. More information is available on the website of the Royal College of Ophthalmologists.
Fellowships
Fellowships in the UK are sub-specialty training opportunities that are no longer under the jurisdiction of the Royal College of Ophthalmologists or any other College. They are open to any suitably qualified ophthalmologist from any country. Appointment is usually by application and interview in competition with other applicants.
Fellowships offer extra training outwith the HST training programmes that lead to the CCST. Prior to the introduction of ASTOs the College kept a National Register of Fellowships; this is now obsolete but many of the recognised fellowships previously listed in the Register have continued to offer the same sub-specialty training posts rather than convert to ASTOs.
Many fellowships are fully funded but some are unfunded or only partially funded.
Fellowships, like ASTOs, may be taken in Oculoplastic and Adnexal Surgery (including lacrimal); Cornea and External Diseases; Cataract and Refractive Surgery; Glaucoma; Retina, Vitreous and Uvea (including intraocular tumour); Neuro-ophthalmology (including eye movement disorders); Paediatric Ophthalmology and Strabismus.
(http://www.rcophth.ac.uk)Royal College of Ophthalmologists