In this page:

Section 1: Information about the writer

Dr Mahmoud Ahmed

ST3, North West Deanery – Manchester, currently at Blackpool Victoria Hospital

Section 2: Scope of practice in the UK:

Ophthalmology provides a good mix of medical and surgical conditions. The main workload is clinic based, with patients rarely requiring hospital admission.

Theatre is essential and Ophthalmology demands excellent hand eye coordination and fine skills. All Ophthalmologists have to be excellent at cataract surgery with a minimum requirement of 50 cases/year for trainees and 100 cases/year for consultants. Different subspecialties have different procedures.

Laser sessions are carried out on an outpatient basis. Consultants do not routinely perform any laser procedures.

 

Section 3: Type of Training/ Route to Training

Run through training from ST1 to ST7

Alternative pathway from ST3 to ST7

LATs only available in Wales and Scotland (only few posts)

Section 4: Subspecialties

Oculoplastics

Focus on eyelids, lacrimal system, thyroid eye disease and trauma. The range of operations is wide, with ‘artistic’ element, including management of tumors and reconstructive procedures.

Cornea and Anterior Segment

Bulk of patients with keratitis, allergies, lid margin disease, dryness, corneal decompensation and dystrophies. Also has a wide range of operations but low number of patients and therefore less consultant posts available. Excellent financial outlook with refractive surgery (private sector)

Medical Retina

Highest workload in all departments. Mainly diabetic retinopathy, macular degeneration and retinal vein occlusions. Other areas of work include uveitis and ocular manifestations of various systemic conditions. Rapidly expanding with new treatments and implants. Excellent chances of consultant posts

Vitreoretinal Surgery

Highly demanding with large and rapid turnover of patients. Considered the most difficult subspecialty to master. Common conditions encountered include retinal detachment, macular holes and epiretinal membranes.

Glaucoma

The ‘lifelong’ specialty. Patients of glaucoma are seen for life and treated mainly medically. Workload includes recognition and management of various types of primary and secondary glaucomas. Exciting new innovations with Minimally Invasive Glaucoma Surgery (MIGS) and selective lasers that could revolutionize this subspecialty.

Paediatric Ophthalmology

Deals mainly with strabismus, including the conservative and surgical management of squints, and retinopathy of prematurity screening

Neuro-ophthalmology

A diagnostic and therapeutic challenge with patients at risk of blindness from various primary ophthalmic and secondary conditions as well as death. Requires good theoretical knowledge and diagnostic acumen.

Ocular Oncology

Reserved for tertiary referral centres, has many interactions with oculoplastics, medical retina, paediatrics and neuro-ophthalmology. Few jobs available.

 

Section 5: Application Process

National application through Oriel

There are Ophthalmology specific interview preparation courses for ST1 and 3. Book these well in advance as they are few and in demand

General interview courses such as ISC Medical are totally useless as they focus on portfolio and motivation questions which you will not be asked on.

ST1:

Application: November / December

Interview: February

ST3:

Application: February / March

Interview: May

 

Section 6: Requirements To Get Into Training (Person Specification):

Please refer to the College website for the full person specification but important points include:

  • ST1 applicants must have 18 months or less experience in Ophthalmology (not including attachments and foundation)
  • Advance life support (ALS) is necessary
  • ST3 applicants must have at least 24 months’ experience in Ophthalmology
  • ST3 applicants must have a certificate of achievement of ST1 & ST2 competences

 

Section 7: Important CV/Portfolio Perks (How To Achieve Them):

The portfolio is assessed in an objective manner. There is no portfolio station so you will not be able to explain or highlight anything on your portfolio. Thus, make sure your portfolio is self-explanatory

It is important to show commitment in all areas of the portfolio.

Research is much liked so try to get published as much as possible.

For ST1, the microsurgical skills course is important while for ST3, a minimum of 100 cataracts should be your target.

For education, attend the training the trainer course (preferably at the college). Also, arrange and provide teaching sessions to A&E, GP and Optometry staff (e.g. red eye, eye emergencies etc.)

This is the scoring system used for portfolios at the ST3 interview

Qualifications Prizes & Awards Other Qualifications Clinical Skills & Experience Surgical & Laser Skills
Max 6 Max 4 Max 4 Max 6 Max 6

 

Multi Source Feedback Publications QI/Audit Presentations Education & Teaching Global Quality
Max 4 Max 5 Max 5 Max 5 Max 5 Max 5

 

Section 8: The Interview

For ST1 interviews, no Ophthalmology experience is necessary so expect questions around any specialty. ST3 interviews are focused on Ophthalmology.

The interview process is very organized.

On arrival, your portfolio is taken from you for marking. You will get it back at the end of your interview.

Next is a 40 minutes preparation stage. You and a few others will be taken to a room where you will be given the interview scenarios and an article.

There are 4 stations divided on 2 rooms each with 2 examiners:

Station A

(Critical appraisal & Improving patient care)

The critical appraisal needs a lot of practice and preparing. ‘How to read a paper’ is a good book to refer to. A common question is the strengths and weaknesses of a paper and bias, limitations and validity.

For quality improvement, make sure you set targets at the beginning and then explain how you will achieve them. You will likely need to describe the audit cycle in your answer. Also, clinical governance is important

Station B

(Communication & Clinical Knowledge)

Usually breaking bad news or difficult patient. Also, explaining a complication or mistake to an angry relative.

Clinical knowledge will be medicine related to Ophthalmology for ST1 like diabetic retinopathy, Graves’ and CRAO and common Ophthalmology cases for ST3 such as retinal detachment, sixth nerve palsy, temporal arteritis and CMO.

quick-tip-e1366327676423

Remember to answer clearly and directly. Give more details and do not wait to be pushed or prompted.

Section 9: Competition Ratio:

ST1                         4.3 per post                        83 posts               (2015 figures)

ST3                         3.2 per post                        11 posts               (2016 figures)

Due to the high competition ratio, there is no Round 2. All posts are filled in ‘Round 1’

 

Section 10: Offers and Visa Issues and HEE

To be continued.

 

Section 11: Speciality Exams

The Royal College London no longer recognizes certificates such as the FRCS (Glasgow), FRCSEd (Edinburgh) and the ICO exams

The Royal College provides detailed information packs for all exams. Please refer to these for more information.

Part 1 FRCOphth (London)
  • Basic sciences related to Ophthalmology. Optics as well as knowledge of ophthalmic instruments and investigations are an important part of this exam.
  • Held in and outside the UK including Cairo and Dubai.
  • Some clinical experience is very helpful before attempting the exam although this is not necessary.
  • Important before applying for ST1 and essential for ST3 applicants.
  • Consists of an MCQ paper of 120 questions and a Constructed Response Question (CRQ) Paper (short answer format, not essays) consisting of 12 questions.
  • The UCL revision course is an intensive 4-day course held in Moorfields, London and is excellent at preparing for the exam. (Ask for the reduced rate for 3rd world countries)
  • Essential references include Snell’s Anatomy of the eye, Elkington‘s Clinical optics and the American Academy of Ophthalmologists Basic and Clinical Science Course volume 2 Fundamentals and principles of ophthalmology and volume 3 Optics, refraction and contact lenses

https://www.rcophth.ac.uk/examinations/part-1-fellowship/

Refraction Certificate
  • OSCE exam on refraction and optometry skills.
  • Held in Birmingham and Glasgow.
  • 12 stations with 10 minutes to refract both eyes.
  • Needs good practice by refracting 80-100 patients the common benchmark to pass.
  • Courses held at Moorfields and Cardiff are important to assess your level. Both provide mock tests.
  • No Ophthalmology experience necessary and little theoretical revision required.

https://www.rcophth.ac.uk/examinations/refraction-certificate/

Part 2 FRCOphth
  • The exit exam consists of 2 separate components: written and oral
  • There is a limit of 4 attempts for each component.
  • The written exam consists of a 180 MCQ paper and the oral consists of an OSCE and a VIVA

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A good idea would be to aim for the written exam earlier (ST4/5) on and have only the clinical exam to do before finishing training (ST6/7)

 

https://www.rcophth.ac.uk/examinations/part-2-fellowship-written-component/

https://www.rcophth.ac.uk/examinations/part-2-fellowship-oral-component/

Section 12: Speciality Courses

Microsurgical Skills Course: 

Essential 3-day course to be able to start cataract surgery and show commitment to Ophthalmology. Run by the Royal College frequently but always in demand so book early to avoid delays (up to 10 months!). Fee £675.00

 

Section 13: Rotations

To be continued.

 

Section 14: Ranking of Deaneries

National Training survey 2015: Overall Satisfaction

Northern Ireland 89
Scotland 88
Wales 88
Yorkshire 88
Thames Valley 87
West Midlands 87
London North 86
South West 86
Kent, Surrey and Sussex 86
East Midlands 86
East of England 85
Wessex 85
North East 84
London South 83
North West 83

 

Section 15: Wages / Take Home Cash

Ophthalmology is one of the most rewarding specialities financially.

 

Section 16: MTI

Dual Sponsorship scheme

  • This helps undertake targeted training in a suitable training post in the UK. Limited to 12 months with a possible maximum extension of 3 to 12 months under exceptional circumstances. Sponsored by the Royal College of Ophthalmologists.
  • The trainee is responsible for arranging a recommendation from an overseas sponsor known personally to the UK consultant who is recommending the trainee for sponsorship.

 

Section 17: Experience of Sudanese Doctors (Personal Experience)

  • Getting a training post in Ophthalmology is difficult as it is highly competitive due to lifestyle and financial factors. There is also a relatively low number of posts on offer.
  • A good plan would be to follow the College curriculum for trainees at every stage and achieve the required competencies with the main aim of applying for ST3 training and, if unsuccessful, then CESR (Article 14) certificate. There is less competition at the ST3 stage compared to ST1 as fewer candidates have the necessary criteria.
  • It is essential to work in a supportive and helpful unit where there is good surgical exposure. Even then, you will have to stand firm and defend your right to be trained. Don’t be afraid to negotiate and demand more training or a rotation in different subspecialties. It is difficult to find a competent and well-trained trust/staff grade and you should use that to your advantage.
  • The University Hospital Southampton provides a CESR training programme where trainees rotate in various departments and are given opportunities to achieve the required competencies to apply through the CESR route. This is a new and promising programme and jobs are usually advertised in May/June.
  • The CESR pathway is becoming more and more accessible and straight forward. It remains a viable option to work for. The Royal College runs a good course to guide CESR applicants.

 

Section 18: Important Links and Websites

 

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Although the information contained on this guide should be fairly accurate, and every effort has been made to check Its details. However, it is possible that some errors have been missed or that some information may have been revised. The information provided by this website are believed to be true and accurate at the date of publication.