11.7  The UK FRCOphth Examination Structure

Mohammad Dehabadi, FRCOphth

The FRCOphth examination consists are 2 parts; Part 1 is a written component examining basic science and optics knowledge, and Part 2 tests clinical knowledge in both written and practical formats.

Part 1 Fellowship Examination

  • No previous clinical experience in ophthalmology is required to sit or pass Part 1 of the FRCOphth examination. It is a test of basic science, as well as optics knowledge. The examination is taken electronically, and candidates are permitted a maximum of 6 attempts at the Part 1 examination
  • Part 1 consists of 2 papers: a 3-hour, 120 question Multiple Choice Questions (MCQ) paper consisting of single best answer questions out of four choices, followed by a 2-hour, 12 question Constructed Response Questions (CRQ) paper. There is a lunch break between the two papers.
  • The commonest books used to prepare for the Part 1 examination are:
    • Basic Sciences in Ophthalmology. Ferris J John Wiley & Sons 1998
    • Clinical Optics. Elkington AR, Frank HJ and Greaney MJ. Blackwell Sciences
  • Finding question banks or books for MCQ paper practice, and past papers from previous candidates for CRQ paper practice are invaluable methods of preparation for the Part 1 exam

Part 2 Fellowship Examination

  • At the time of writing, the RANZCO RACE Clinical Examinations are held over a two-day period. Nine stations each day (total of eighteen stations) are completed, with nine minutes to complete each station and two minutes to move between stations
  • Two stations of each of the nine-core topic areas must be included, although not necessarily one each day. Each station is run by an ophthalmologist. Not all stations have live patients. The ophthalmologist may or may not be a sub-specialist in the area you are being examined in, but the passing standard is always that of a safe general ophthalmologist
  • Failure in both stations of a core topic will usually result in failure of the examination
  • There are no tricks to passing the RACE clinical examinations. Candidates who have seen a large diversity and number of patients / surgeries on busy terms throughout their training seem to do well. When stuck, thinking what you would do usually on call, in the emergency department, or in clinic or theatre will get you out of many stressful scenarios

Structured Viva

This component consists of five 10-minute stations, where the candidate will be examined by one examiner. This portion of the oral exam is used to test knowledge of landmark studies and college guidelines, interpretation of investigations, and management of rare cases which are difficult to examine in an OSCE setting. In each station, a clinical or ethical vignette is usually used to test the candidate’s knowledge in the following domains:

Station 1: Patient Investigations and Data Interpretation
  • This station can cover any ophthalmic or radiological examination used in clinical ophthalmology. It often takes the format of a case history, where sequential investigations of the same patient are presented for the candidate’s interpretation and discussion. E.g. a trauma case can be presented, with a CT head for interpretation, followed by a HESS chart, leading to discussions of orthoptic and surgical management
Station 2: Patient Management 1
  • This station can take any case history to form the basis of an in-depth discussion of symptoms, signs, investigations, and management of common adult or paediatric presentations. Often photos, or investigations may also be presented to the candidate for interpretation during the discussion. As more stable patients can be brought to the OSCE stations, this station is often used to cover more acute, or rate presentations such as malignancy, trauma, or paediatric cases
Station 3: Attitudes, Ethics and Responsibilities
  • This station involves a vignette of “difficult cases” or “difficult colleagues”. You could for example be asked to run through how you would manage a patient with refractive surprise post cataract surgery, or a consultant colleague suspected to be under the influence of alcohol or drugs in the workplace
Station 4: Audit, Research and Evidence-based Practice and Health Promotion and Disease Prevention
  • This station is often used to have an in-depth discussion of landmark clinical trials, college guidelines, or a more abstract discussion of the audit or clinical governance process as a whole. Example cases may include a discussion of a patient with CRVO, leading to questions regarding landmark trials, or a patient on hydroxychloroquine, leading to a discussion of the latest college guidance on screening
Station 5: Communication Skills (Officially Part of the OSCE, but Examined in the Viva Setting)
  • This station involves an actor, a lay examiner, and a consultant ophthalmologist examiner. The candidate is often required to break bad news, discuss a new diagnosis, or have a difficult discussion with a patient. Example cases could include discussion of refractive surprise or telling a glaucoma patient that they no longer meet the DVLA’s driving standards. You are given a 1 minute warning to wrap up your discussion with the actor

Objective Structured Clinical Examination (OSCE)

  • This component consists of five 20-minute stations divided into specific sub-specialties. In each station, the candidate will have to examine 3 distinct patients, describing their examination findings, and answering any questions the examiners may have on a specific area on each case. The first patient will be waiting for you in the examination room, but patients 2 and 3 will often be seated outside where you will be waiting. You may therefore be able to start to gather your thoughts about patients 2 and 3 while waiting if there are any obvious gross clinical signs
  • Due to the time pressure in this component of the exam, the examiners may ask that you examine a very specific part of the patient. It is therefore important that you practice being able to break from your complete examination routine and carry out only specific parts of each system examination
Station 1: Anterior Segment
  • All three patients will require a slit lamp examination of the anterior segment. Common cases include corneal dystrophies and grafts, as well as cases with previous trauma, anterior segment dysgenesis, or corneal ectasias such as keratoconus. It is not uncommon to have a glaucoma case among the three patients in this station
  • Common follow up questions in this station include inheritance patterns of the dystrophy in question, or indications for different types of corneal graft
Station 2: Glaucoma and Lid
  • The glaucoma patients in this station will either have a secondary glaucoma syndrome with signs, glaucoma drainage devices, or you will be asked to comment on discs. The questions that follow will often involve the step-by-step management of such cases in your practice, or landmark trials and therapeutics. You will not be asked to perform gonioscopy
  • The lid cases can range from ptosis, entropion or ectropion, to assessment of a patient with blepharospasm, with follow up questions on the management of such cases
Station 3: Posterior Segment
  • At least one patient in this station will require an indirect examination without indentation, with the others requiring slit lamp biomicroscopy. Cases can vary greatly, from simple diabetic retinopathy grading, to a multitude of posterior uveitis cases, or stable peripheral retinal pathology such as retinoschisis. Follow up questions will involve therapeutic options for the condition in question, or landmark trials
Station 4: Strabismus and Orbit
  • Common cases in this station involve stable oculomotor palsies, thyroid eye disease, and common strabismus diagnoses. It is important to be slick at the orbital examination as at least one patient will require this. Don’t forget to observe the patient for facial asymmetry (such as orbital hypoplasia following radiotherapy as a child, or temporal fossa fullness in a sphenoid wing meningioma). It is not uncommon to encounter a patient with a prosthesis in this station, in which case ask the examiner if they would like you to examine the socket before asking the patient to remove this
  • Follow up questions in this station often involve the management options for the treatment of strabismus, or the differentials and investigation options for orbital pathology
Station 5: Neuro-ophthalmology
  • The patients in this station could have a wide of diagnoses. You may be asked to carry out visual field testing to confrontation, examination of the optic nerve using a direct ophthalmoscope, or to carry out a pupil examination (do not forget to ask to examine the pupil on a slit lamp if one is provided to avoid missing signs such a vermiform movement of the iris). Start the visual field testing with a quick assessment of the patient’s visual acuity if a chart it provided, as it can be awkward and time consuming to attempt mapping out a visual field in a patient with PL or NPL vision

          

All rights reserved. No part of this publication which includes all images and diagrams may be reproduced, distributed, or transmitted in any form or by any means, including photocopying, recording, or other electronic or mechanical methods, without the prior written permission of the authors, except in the case of brief quotations embodied in critical reviews and certain other noncommercial uses permitted by copyright law.

Vitreoretinal Surgery Online
This open-source textbook provides step-by-step instructions for the full spectrum of vitreoretinal surgical procedures. An international collaboration from over 90 authors worldwide, this text is rich in high quality videos and illustrations.

© 2021 WESTMEAD EYE MANUAL

Website by WebInjection