Applying to Ophthalmology

Ophthalmology provides a great deal of variety by combining medicine, surgery & A&E. It is predominantly an outpatient specialty with plenty of opportunities to subspecialise. Competition for posts, however, can be quite fierce and hence a strong portfolio may be necessary to secure your place.

Why Ophthalmology?

Ophthalmology involves intricate microsurgery that can often provide almost instant gratification; one of the most commonly performed is the cataract operation. There are ample opportunities to work abroad and to make a real difference in terms of global health. In addition, Ophthalmology involves the use of a variety of instruments, including microscopes, lasers, cameras and more, making outpatient clinics much more active, interesting and enjoyable, compared to other specialties. It is a specialty that is at the forefront of medical research, innovation and technology, and there are countless opportunities to get involved with research. There is a multitude of sub-specialties to cater for everyone, so you can really tailor your career to suit your own skills and interests (e.g. Cornea, Retina, Paediatrics, Neuro-Ophthalmology). 

One of the most important reasons to choose this specialty is that Ophthalmologists are notoriously happy, fulfilled and all-round nice people, who tend to have a relatively good work-life balance; what more could you want?!

What is the training programme like?

The training programme is 7 years long and is run-through after FY2 (i.e. it is not necessary to complete core surgical or medical training prior to specialising). 

A day in the life of an Ophthalmologist…

The day-to-day life of an Ophthalmologist involves a mixture of outpatient clinics, eye casualty clerking shifts and surgical theatre lists. In addition, many Ophthalmologists are involved in teaching (at both an undergraduate and postgraduate level), as well as research projects and private work. 

How do I apply?

Ophthalmology truly is a fantastic specialty and, therefore, the recruitment process can be quite competitive. Once you’ve identified that you might be interested in a career in Ophthalmology, it’s important to seek out further experiences and to start accruing those vital points for your application, as soon as possible! Luckily, there are lots of things you can do, no matter what stage of your training you are at. 

This article outlines the application process, including a brief timeline and how to best prepare for each section.

Timeline for applications

NovemberApplications open on Oriel (the same website you will have used for F1/F2)
DecemberBookings for the Multi-Specialty Recruitment Assessment (MSRA) open
Early JanuaryMSRA
Late JanuaryInvitation to interview
Early FebruaryInterview
A few days post-interviewSubmission of job preferences
End of FebruaryOffers
AugustStart ST1

Oriel application

This part of the application is fairly straightforward; you simply enter your details into the online application form, ensuring you meet the Person Specification, which includes:

  • MBBS or equivalent medical qualification
  • GMC licence to practise 
  • Completed (or due to complete) Foundation Training within 3.5 years of the start date
  • Eligible to work in the UK
  • 18 months or less experience in Ophthalmology by the time of interview date

Multi-Specialty Recruitment Assessment (MSRA)

If you meet the eligibility criteria (as described above), you will be asked to book an MSRA slot. This is an online exam that can be taken at a variety of Pearson Vue Computer Testing Centres, throughout the UK. You can take the test at any time within a 2 week period, but the booking process is first come first served, so the sooner you book, the more likely you are to get your preferred test time and location. You must reach a predefined score in order to obtain an interview, and your MSRA score will count towards your final application score (you can score a maximum of 40 points on the MSRA, out of a potential total application score of 300).

The test is split into 2 sections:

Section 1: Professional Dilemmas (Situational Judgement Test)

What it covers: Professional integrity Coping with pressure Empathy and sensitivity

Time: 110 minutes

Questions types:

  • 29 Ranking questions: Rank all responses in order of appropriateness, as discrete actions.
  • 29 Multiple Choice Questions (MCQs): Choose the three best responses out of eight. Taken together, the three responses should fully resolve the situation.
Section 2: Clinical Problem Solving

What it covers:

  • Cardiology
  • Dermatology / ENT / Ophthalmology
  • Endocrinology / Metabolic
  • Gastroenterology / Nutrition / Infectious diseases / Haematology / Immunology / Allergies / Genetics
  • Musculoskeletal
  • Paediatrics
  • Pharmacology & Therapeutics
  • Psychiatry / Neurology
  • Renal / Urology
  • Reproductive
  • Respiratory

Time: 75 minutes

Questions types:

  • 43 Extended Matching Questions (EMQs): Presented with 7-10 response options, followed by multiple questions linked to this response set. Select the most appropriate response for each question. Each response can be selected once, more than once or not at all.
  • 43 Single Best Answer Questions (SBAs): You are given a scenario and must select the single most likely answer/diagnosis out of 5-8 response options.
  • A few Multiple Best Answer Questions (MBAs): You are given a scenario and must select the two or three most likely answers out of 6-8 response options.

How to prepare:

  • It takes about 1-2 months to prepare
  • Revise the 12 specialties covered in the Clinical Problem Solving section,
  • using your own notes from Medical School, textbooks, etc. (remember, you will
  • not need to know about the topics in too much detail. The assessment is based
  • on Foundation-level clinical practice)
  • Use an online question bank (e.g. Passmedicine, MCQ Bank, etc.)
  • Complete the MSRA sample questions
  • Take a generic tutorial to familiarise yourself with the controls and screen
  • layouts in advance (on Pearson VUE website)


All interviews are held on the same day, in the same location in Bristol. To prepare, it is best to view the interview like an exam and practise/revise for each section, for 2-3 months prior. On arrival, you will be asked to hand over your paper portfolio for the portfolio review station (further details below). You will then be given a 40 minute preparation period. During this time, you will have a number of scenarios to read and a published paper to review.

The interview consists of 5 key sections:

Section 1: Paper portfolio (Maximum 100 points)

This is where you can really start preparing early, gathering evidence and experience from Medical School onwards. On arrival at the interview, you hand your portfolio in and then receive it back, with feedback attached, at the end of the interview. Therefore, it is crucial that the portfolio is clear and concise, as you will not be able to talk through it at any stage. The portfolio itself is split into the four following sections, with points obtained for each piece of relevant evidence within each section:

1) Education

  • Qualifications
  • Intercalated degree, MSc, BA, BSc
  • MD thesis
  • PhD or DPhil
  • Prizes/Awards
  • 1st in Undergraduate degree
  • Best paper/poster at a National or International Meeting
  • National Undergraduate prize (e.g. Duke Elder Prize – 1 point for coming in top 60%, 2 points for top 10%)
  • NB: The Duke Elder Undergraduate Prize Exam and The Patrick Trever-Roper Undergraduate Travel Award are both open to medical students. You can find out more about them and other prizes by visiting the RCOPHTH website for awards and prizes and other key information for medical students and foundation doctors.

2) Training and Experience

  • Ophthalmology specialty links and commitment to date as a career: Elective in Ophthalmology 
  • Ophthalmology taster week during Foundation Training
  • Attendance at Regional, National or International Ophthalmology courses/meetings 
  • Non-peer reviewed publications and case reports (as the first author)
  • Presentations at undergraduate meetings
  • EyeSi surgical simulator assessments (minimum 4 hours)
  • Attending Eye clinic and theatre sessions (minimum 10 sessions)
  • Microsurgical Skills Course (newly titled “Introduction to Ophthalmic Surgery Course”)
  • Multi-Source Feedback (e.g. TAB assessment, which is a compulsory requirement of F1/F2 training)

3) Audit, Research & Teaching

  • Publications (Each publication in a peer-reviewed journal is scored by multiplying the journal’s impact factor by your authorship. First author = 4, Second author = 3, Third author = 2, etc. The maximum points in this section is 10)
  • Quality improvement/Audit projects: Copy of your best QIP/audit in the last 3 years
  • Presentations: Regional presentations, National presentations, International presentations
  • Education and Teaching: Designing an educational course or e-learning tool
  • Teaching the teachers course
  • Formal role in examining undergraduates
  • Writing a chapter in a textbook or writing a book
  • Higher teaching qualification

4) Overall portfolio layout & quality

Section 2: Critical Appraisal (Maximum 30 points)

You will have been given a published paper to read and review during the preparation session, as well as the primary questions that will be asked about the paper.  There will be 2 panellists, who will ask you these questions and will have positive and negative indicators to listen out for in your answers. This station lasts 8 minutes.

To prepare for this station:

  • Learn how to critically appraise an article (including concepts such as Intention to Treat, Number needed to treat, bias, confounding, study designs, relative risk, odds ratio, etc.). There are a variety of online resources, face-to-face courses and textbooks available to help with this.
  • PRACTISE!! Start a few months before the interview and aim to critically appraise at least one article a week. Gradually work towards doing this within a 20 minute timeframe

Section 3: Improving Patient Care (Maximum 40 points)

You will be asked a series of questions related to improving patient care, usually regarding a QIP or audit. You will have the opportunity to prepare for these questions during the preparation session. This station last 8 minutes.

To prepare for this station:

  • Learn about “SMART” objectives and the “PDSA” cycle for QIPs/Audits
  • When answering relevant questions, ensure you structure your answers around these concepts
  • Practise planning QIPs/audits for given scenarios, and giving these answers concisely
  • Revise key clinical governance concepts

Section 4: Communication Scenario (Maximum 40 points)

This scenario will involve role-playing with an actor.  You will have been given a patient history to read as part of the preparation. This station lasts 7 minutes.

To prepare for this station:

  • Practise role-playing difficult patient scenarios with a friend or colleague
  • Key points include gaining a good rapport, listening and showing empathy, being honest, providing clear explanations and non-verbal skills

Section 5: Clinical Scenario (Maximum 50 points)

This station involves identifying clinical signs or describing the results of an investigation, which will involve viewing photographs on an iPad. It will be based on an Ophthalmic condition (often one which has systemic features) and there will be primary clinical questions, followed by supplementary questions. 

To prepare for this station:

  • Start early and revise common Ophthalmic conditions, including their signs & symptoms, risk factors, diagnostic investigations, management, etc.
  • Some key revision topics may include: Diabetes and diabetic retinopathy, Papilloedema, Retinal vein/artery occlusions, Glaucoma, AMD, Myasthenia Gravis, Thyroid eye disease, Ptosis, Horner’s Syndrome, Nerve palsies, Neurofibromatosis.
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Useful Resources

Written by Dr Alice Bellchambers (FY2)

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