11.7  The UK FRCOphth Examination Structure

• 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

• In the Part 2 examinations, the candidates are expected to demonstrate a depth of knowledge and understanding expected of an independent specialist (consultant), not sub-specialising in the field being tested. Both written and oral parts need to be passed in order to become a fellow of the Royal College of Ophthalmologists
• The written component consists of two 90 question MCQ papers running over 2 hours each, which can be conducted from home in an “Online Proctored” format.
• The format of the oral component of the Part 2 examination is outlined below:

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:

• 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

• 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

• 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

• 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

• 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

• 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

• 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