How to get your Ophthalmology Number * Updated March 2024*

Getting into Ophthalmology is becoming increasingly competitive- but with hard work and the right advice, you can get your dream job!

There are three key components which you will be scored on during the national recruitment process:

1. The MSRA

2. The Portfolio

3. The Interview

You can find more advice on each of these components below.

Before we get into the details, we want to dispel some myths:

1. Myth 1: You will do better if you know the right people or trained in the area you want to work in. The process is fundamentally objective. It does not matter which medical school you attended or where you trained. If you tick the box, you will score the point. Getting to know people might help you get some projects for your Portfolio, but if you're new to the ophthalmology world, it's not a deal breaker.

2. Myth 2: You will do better if you spend money on expensive courses. The best resources for all components of the process are free or affordable. We will do our best to explain when we spent money and whether it was worth it.

3. Myth 3: You need to pass the Duke Elder exam. You can score 1-2 points out of 100 by passing the Duke Elder Prize exam. It is not essential.

4. Myth 4: Everything in your Portfolio needs to be ophthalmology-focused. While there is a commitment to the Specialty section in the Portfolio, most areas, like publications and QIPs, do not need to be ophthalmology-focused for you to score full marks.

5. Myth 5: The MSRA is an easy exam and doesn't require much prep. Without a good MSRA score, the rest of your Portfolio will not be scored, and you will not progress to the interview. While many find the exam easier than finals, your score must be competitive.

Right, let's get to it. We have included a collection of advice below for each section, MSRA, Portfolio and Interview, to get you on track:

1. MSRA exam

As of 2023, only the top-scoring 300 applicants in the MSRA will progress to have their portfolios reviewed, and only those applicants scoring >40% in the portfolio will be invited to participate in the interview.

Exam Structure

The MSRA is 170 minutes in length, and there are 2 parts - a Professional Dilemmas (PD) paper and a Clinical Problem Solving (CPS) paper. The papers are time separately, so if you finish the PD paper early, you will not have extra time for the CPS paper.

1. Professional Dilemmas (PD) paper- The PD paper consists of 50 items, and there are 95 minutes in which to complete the test. Only 42 items account towards the final score, as 8 of the items in each test paper are being tested ('piloted') before use.

2. Clinical Problem Solving (CPS) paper- The CPS paper consists of 97 questions, and there are 75 minutes in which to complete the test. Only 86 items account towards the final score, as 11 items in each test paper are being tested ('piloted') before use.

More details on the exam blueprint can be found here, using the MSRA Test Blueprint & Information.

Booking / Sitting the exam

When you submit an application to ST1 Ophthalmology on Oriel, you will automatically be enrolled to sit the MSRA. The exam usually takes place in early January, and you will need to take the MSRA at a Pearson Vue centre:

All slots for all centres are released simultaneously, and you will receive a text/email from Oriel when they are released. Often, there are a limited number of slots in some popular areas like London, so you need to book early. In addition, some slots are one to two weeks later than others, and the later slots book up quickly.

The exam is generated by selecting a number of questions from a pre-approved question bank. The questions from previous years have been repeated.

Revision Advice

Currently, many resources are out there to help with MSRA prep. As this section of the application process is not ophthalmology-specific, we have included only the essential details. Other valuable resources are linked below, but please note that you don't need to spend much money. Many of us only used question banks and still received top scores. The best prep comes from using the sample exam papers certified by Health Education England and the GMCs Generic professional capabilities framework for the PD paper.

Resources for the MSRA

- Medibuddy- The free advice is great, and we have achieved top scores without paying for any additional courses or resources.

- Both Emedica and Passmedicine have question banks, which are useful for revising the clinical knowledge questions.

2. Portfolio

At present, the Portfolio will make up 50 /100 of your final score.

Currently, your Portfolio is the area which will take the most work and preparation. It is also an excellent opportunity to boost your score because it is the most predictable aspect of the application process.

We highly recommend you keep a close eye on the Severn Recruitment website, which contains the most reliable information about how assessors will score your Portfolio. We have used this to inform the advice below.

Domains used to score

1. List of previous posts- This item is to ensure you are at the correct training grade. It is not used to score your application. If you are not in a clinical post, be sure to make this clear, as this will mean that time-sensitive components of your portfolio, such as the date of QIP completion, are less likely to expire.

2. Qualifications with certificates or letters of proof 5 points max

Here, you can score for previous qualifications, but intercalated degrees do not score. The MRCP and MRCS do not score.

3. Prizes/Awards with proof 5 points max

Duke-Elder Alert undergraduates! Here, you can score if you can top at med school or take the Part 1 exam. You can also score 1 point here if you come in the top 60% of those taking the Duke-Elder exam or, better yet, 2 points if you come in the top 10%.

Distinctions Awards for coming in the top 20% during undergraduate exams will also earn points, but your evidence must specifically include your rank stating top 20%. Get a signed letter ASAP.

Best Presentation The easiest way to score as a post-graduate is to achieve the best poster/ oral presentation at a conference or receive research grant approval. A travel bursary does not score. Our advice here would be to submit your projects to conferences where they are most likely to win, hence not always the most prestigious conferences.

• NOTE- You cannot re-use evidence. For example, if you win best poster, you must prove this with a certificate. You cannot re-use the same letter from your consultant you used to evidence the presentation in the presentations section.

4. Ophthalmology specialty links and commitment to date as a career 12 points max This section is where working hard (and jumping through hoops) will likely make a big difference. Pay close attention to scoring, as many half marks are awarded in this section.

Non-peer reviewed publications and case reports now go in this section- these will not score in the publications section, so don't risk it.

Dig up evidence for SSCs in ophthalmology or other undergraduate projects- doing so can score you up to 2 points (that's as much as the refraction certificate!!).

Note that meetings attended will score you a maximum of 3 points, and one regional meeting is only 0.5 points.

• NOTE- Say you presented a poster at a meeting. You need different evidence for each section to receive points in both the presentation and commitment to specialty section. Hence, as certificates are not accepted in the presentation part of the Portfolio, we would use a certificate of attendance to score as a meeting in the commitment to specialty section and a letter from your consultant evidencing presentation in the presentations section.

Regarding the FRCOphth Part 1 exam, it's helpful to sit as you will have to do it anyway, and it will score you a significant 3 points. However, it is a time-intensive aspect of the Portfolio. The exam is not easy to pass, and it is not cheap. Unlike other specialities, it is common for trainees (in London and elsewhere) to wait for their number before sitting the exam. The same goes for the refraction certificate.

Getting EyeSi assessments done can be a considerable effort in some areas. Because the machines break easily and are hard to fix, most hospitals will only let trainees use them. The Royal College of Ophthalmologists have a sign-up process and wait list:

5. Multi-Source Feedback (MSF) Max 3 points

The critical thing is that your MSF will expire in 18 months. If you are an F3, you must pay close attention to this. We recommend you do an MSF late in F2, even if you've already done ARCP, so you can use it for as long as possible.

Be bold and make your colleagues aware of the value of comments like "best trainee worked with."

6. Publications Max 6 points

Notice that the journal impact factor does not matter. The publication must be peer-reviewed and cannot be a case report.

There is a big scoring difference between publications by the second and first authors. If you are beyond the fifth author, you will score no points. If there are more than eight authors, you will only score if you are the first author.

While there is a note that the quality of the publication will be considered, we know people who were more than the 5th author on very prestigious (Cochrane) publications that did not score.

7. Quality improvement / Audit projects Max score 5 points

The only way to ensure maximum points here is to publish your project. Demonstrating National impact is likely to be harder. Be strategic with the write-up to score full points and make it clear that Standards, Outcomes and Recommendations are addressed.

Remember, the supervising consultant must sign the report.

• NOTE again, you cannot use a QI/ audit publication in the QI /Audit section and the Publication section.

8. Presentations Max score 6 points

Here remember, a certificate will not count as evidence. Get signed letters from consultants as soon as you can after a conference. Write the letter for them and just ask them to sign it.

Be aware that all points Severn Recruitment displays are HALVED for posters / second author presentations.

If you are struggling for time, consider applying to virtual conferences, as this can be a quicker and cheaper way of scoring points.

9 Education and Teaching Max score 5 Points

If you decide to take an F3, doing a teaching fellow post that funds a PGCert in medical education is a good move. So far, they will count enrolment in the course even if the qualification is incomplete at the time of application. Some academic Foundation Jobs will Fund PGCerts, so it's worth checking.

Things to check before choosing a PGCert in Medical Education:

1. The qualification is on the list of courses accredited by the Academy of Medical Educators found here.

2. Mapped against accreditation by the Higher Education Academy.

Virtual PGCerts in medical education, such as a popular one at Cardiff, will cost between £3500 and £ 6500 for UK students and require regular assignment submissions, depending on how you set up student teaching. We recommend this only if you are already taking an F3 or similar, but the option is available from F1 onwards.

Also- if you're still in med school, do a masters in Medical Education as your intercalated degree if you're interested in teaching. It counts for this Portfolio section and will be helpful later on, even in consultant interviews!

Many medical schools are looking for OSCE examiners. SGUL are a good option! Get in touch- teaching fellows are good people to ask. You'll be surprised how easy getting involved can be. Also, teaching fellows often run mock exams and may let you act as an examiner.

The two-day Oxford Medical Education Teach the Teacher Course is a popular "teach the teacher" course. Most foundation schools will fund it with your study budget. The dates book up quickly, so it's worth getting in early to ensure you complete the course before the portfolio deadline.

10. Overall portfolio quality Max score 3 points A controversial section. Highlight and underline information in your evidence to help assessors. It has become increasingly difficult to score 3 points over the years.

The best way to score points is to make your PDF content page for each section and embed hyperlinks that take the reviewer straight to the evidence. A link back to the contents is also advised. For full marks, this is still not enough; evidence must be immaculately laid out and colour-coded.

3. Interview

In 2024, there were two stations. Both stations focused on a conversation with an actor. The first station focused on clinical knowledge and the second on communication skills and ethics.

Key points:

• Interviews were still virtual in 2024 using software called Qpercom:

• Interviews were scored based on interactions with the actor only. Panellists were there but did not ask questions.

• 5 minutes of reading time before entering the room and 8 minutes with the actor.

• You need an ID (passport or driving license).

Revision Materials for the interview:

1. STInterview.com is the best prep course available in our opinion: