So, you want to be an Ophthalmologist?

By Periklis Giannakis

If you want to become a surgeon that has nothing to do with body medicine but focuses on the eyes, then you are on the right blog. Being an ophthalmologist is more than just checking peoples’ eyes, and giving them eye drops. It is also doing super intricate eye surgeries to restore vision or at other times teach medical students or residents the craft, and create your own medical device or lead your own private practice. You will always be using cutting-edge technologies and no robots will ever be able to replace you.

So, you have decided you want to become an ophto-pod, so what is next in the UK?

Programme overview:

After around 2 weeks of ophthalmology rotations at medical school, you will graduate and enter the classic or specialised foundational programme (SFP) and then you have the choice of entering immediately into ophthalmology residency which lasts 7 years; or do an Academic Clinical Fellowship in Ophthalmology for 3 years leading another 3 years of part-time PhD, part-time ophthalmology training to become a consultant. Most graduates of ophthalmology residency, if they haven’t done a PhD, will need to do one and a fellowship in a sub-speciality of interest before they become consultants. In general, ophthalmology residency is one of the most competitive ones to get into, so preparing early is key for success. According to the 2021 recruiting data, there were only 85 ST1 ophthalmology posts in the whole of the UK. (https://severndeanery.nhs.uk/recruitment/vacancies/show/oph-st1-2022/applicant-guide-lib)

Application process:

The application mainly consists of two important components: Multi-Speciality Recruitment Assessment (MSRA) and the evidence folder, which is your portfolio. The former is a 170-minute exam made up of every medical student’s fear, the Situational Judgement Test (SJT) which takes up 95 minutes of the exam; the rest is general medical questions. (https://severndeanery.nhs.uk/recruitment/vacancies/show/oph-st1-2022/msra-lib)

If you are shortlisted based on your MSRA score, you will then be invited to attend an online interview (Online Assessment) which involves an assessment of your evidence folder and mini-OSCES. After the interview, you are given a global score based on all these three components: MSRA counting for a maximum score of 20 points, evidence folder counting for a maximum score of 50 points; and the online assessment counting for a maximum score of 30 points. (https://severndeanery.nhs.uk/recruitment/vacancies/show/oph-st1-2022/applicant-guide-lib ) The application timeline is shown in Figure 1.

Figure 1: This is the application timeline for ophthalmology match for the 2021 application cycle. (https://severndeanery.nhs.uk/recruitment/vacancies/show/oph-st1-2022/recruitment-timetable-lib)

How can you increase the odds?

(https://severndeanery.nhs.uk/recruitment/vacancies/show/oph-st1-2022/evidence-folder-lib)

From looking at the weighting of the evidence folder, the wise choice would be to capitalise and invest on that from early on to allow ample time to max it out before applications. Although, some components like FRCOPhth Part 1 can’t be done during medical school (have checked with the Royal College of Ophthalmologists, and they don’t allow medical students to sit it ). The good news is that other than that everything else can be done during medical school. In this section, we will cover the evidence folder domain by domain with ways to max it out.

Other Qualifications

Although, intercalated degrees have fallen out of fashion especially after FPAS dropped them from their selection criteria, for residency applications it is highly desirable. I remember myself during my third year deciding what to intercalate on; no matter what you intercalate on it will give you a maximum of 1 point unless you have done multiple in which case it would count for more. So, consider intercalating if you can.

Prizes & Awards

This is much easier to capitalise on, as there are endless opportunities to get awards and they don’t have to be in ophthalmology. The best way to go about publications is to find a friendly ophthalmologist mentor to help you; when you find that person hold them tight as they will be the best person to help you make your dreams come true. I have found that ophthalmologist mentors are so nice and as the relationship develops, they become great friends and people to look up to. Preparing for the Duke Elder Exam is vital, and people can have different experiences, but all of them revolve around good preparation. Preparing well in advance like 3-4 months beforehand should be enough for top 10%. I remember sitting the exam when I was a first year with zero prep and scoring top 40% in the country. You can sit the exam every year if you want until you graduate, but bear in mind that if you score let’s say top 10% and sit it again then your most recent score will be used, not your best score (based on what the Royal College of Ophthalmologists have told me).

Commitment to speciality

Other than FRCOPhth Part 1 and Refraction certificate, all other things can be done during medical school. ‘Please see the previous table for more information. My advice is the same as before; find a lovely ophthalmologist to help you and you can max this out easily.

Multi-Source Feedback

Extremely easy to achieve maximum points on this as everyone wants to help you succeed; just choose wisely who knows you enough to contribute meaningfully to this. Follow this link for more information: https://severndeanery.nhs.uk/recruitment/vacancies/show/oph-st1-2022/msf-guidance-lib

Research

Research is always important and really helps differentiate you; that’s why it takes up 16 out of the 50 points of the evidence folder. From personal experience research, as many mentors say, is a slow burn; takes a lot of time to complete and sometimes it never gets published. My advice is to start early and work hard as your mentors invest a lot of time to teach you how to do stuff. Also, consider getting experience from different types of research like case reports, and original investigations as the more the better. In the eyes of the examiners, it may not matter if you have 10 case reports or 0 original investigations but that you have enough to max out. Again find a friendly mentor to help you achieve those points. It doesn’t matter if the projects are not in ophthalmology so long as it is research.

Teaching

For this domain, look into doing a Training the teacher course, and teach at your medical school as part of societies and it should be fine. Writing a book takes time and between me and you, you can get more out of your time by publishing more papers than by writing a book.

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