GUIDE TO CANDIDATES
Purpose of examination
The main objective of this examination is to ensure that trainees have the appropriate skills and knowledge to take up an independent specialist post at the standard required of a consultant in the UK.
Criteria for success in the examination
As this is a competency-based examination, the examiners will be asked to assess your competency in each section. At the end of each section, you will be formally assessed as “competent” or “not competent”. At the time of first taking the exam, all candidates will take all sections of the exam.
To pass the whole examination, you must have been assessed as “competent” in all sections.
Candidates who are assessed as “not competent” in one or more orals and/or clinicals will have to re-take only those orals and/or clinicals at a resit examination.
Success in the examination will entitle the candidate to the award of the FRCSEd (Ophth) Diploma.
The Syllabus clearly defines the areas covered by the examination and is carefully adhered to by the examiners. These guidance notes will be regularly updated, using feedback from examiners and candidates. Feedback will inform any future changes to the exam format.
The exam consists of 3 separate components
1. Written paper
2. Structured orals
3. Objective Structured Clinical Examinations (OSCE)
Written paper
Extended matching questions
What are extended matching questions (EMQs)?
EMQs are similar to MCQs, but are normally more clinically orientated. They give a number of brief clinical scenarios, and a list of options to match with the scenarios.
The title of the area to be tested is given first, then the list of options, then a lead-in statement to link the options to the clinical scenarios, then the list of clinical scenarios (questions).
An example:
Title: Causes of acute visual loss
Options
- A Central retinal artery occlusion
- B Arteritic anterior ischaemic optic neuropathy
- C Non-arteritic anterior ischaemic optic neuropathy
- D Central retinal vein occlusion
- E Retinal detachment
- F Subretinal neovascular membrane
- G Retinal platelet-fibrin embolus
- H Traumatic optic neuropathy
Lead – in statement
• For each case described below, choose the single most likely cause of visual loss from the above list of options. Each option may be used once, more than once, or not at all.
Questions
• Question 1
• A 84 year old female presents with sudden complete loss of vision in the right eye. She has had temporal scalp tenderness and jaw claudication for 2 weeks.
• Question 2
• A 23 year old myopic male presents with rapid onset of visual loss in the left eye over a period of hours. He describes the loss of vision as if a curtain has been coming up from below, progressively obscuring vision in the left eye.
• Question 3
• A 75 year old male, who smokes, complains of progressive distortion and loss of the central part of the vision in his right eye over a period of 3 days.
• Question 4
• A 80 year old female, who smokes, complains of transient loss of vision in the left eye for about 20 minutes, which then recovers.
• Question 5
• A 13 year old male notices loss of vision in the temporal field of the right eye immediately after being accidentally knocked on the right side of his head with a baseball bat.
2. Structured Oral Examinations
Structured oral questions which will cover the 7 major subspecialty sections of the syllabus of the FRCSEd (Ophthalmology). The eighth viva assesses a submitted research report, audit report and personal surgical outcomes analyses. Each of these oral examinations will last for 20 minutes.
In these orals, the emphasis is on clinical and practical problem solving, using clinical scenarios and structured questions.
These orals are designed to assess your practical knowledge over a wide area, and short, succinct answers are expected. Some of the questions may be quite simple, you should not suspect a “trick” question if the answer seems to you too obvious. These orals cover a lot of ground, so out of necessity, the examiners may seem to be “jumping around”.
The structure of each group of questions may vary, but generally speaking, each topic will start with one or two simple introductory questions, then one or two more difficult questions, and may on occasion end with a simple question designed to help to move on to the next topic. A sample question is appended to this document (Appendix A).
Guidance on how to prepare the research and audit reports is given in the documents “Summary of Audit Cycle” and “Summary of Research Submission”. Guidance notes on the assessment of generic topics are contained in Appendix B of this document.
3. Objective Structured Clinical Examination (OSCE)
This clinical examination section will include assessment of relevant patients in 3 different areas ie Anterior Segment, Posterior Segment and Medicine/Neurology in relation to Ophthalmology.
Each section will be 15- 20 minutes in duration.
A candidate who is not successful in a particular section will need to resit only that component.
These OSCE examinations will be at a higher level than the OSCEs which are included in Part B.
After you register, you will get your lessons.
To receive the lessons, please and a mail to: profpmuthusamy@gmail.com
Criteria for success in the examination
As this is a competency-based examination, the examiners will be asked to assess your competency in each separate area examined. To pass the whole examination, you must have been assessed as “competent” in all vivas & clinical exams- in addition the written paper must also be passed. Candidates who are assessed as “not competent” in one or more vivas or clinicals will have to re-take only those vivas or clinicals at a resit examination. Failure in the written component only will require a resit in the written paper
Appendix A Sample viva questions
Appendix B Guidance on generic medical issues
Notification of results
Examination results will be posted on the Royal College of Surgeons of Edinburgh website, www.rcsed.ac.uk normally within one month of completion of the examination. Candidate examination numbers will be used for identification. Candidate names will not be posted. Results will be mailed to candidates within one month of completion of the examination. 4
APPENDIX A SAMPLE VIVA QUESTION
VIVA No. 4 AREA GLAUCOMA
Letter and name of topic D. Surgery
Aspect of topic Management of complications of glaucoma surgery
Introductory question Notes on answer
(to get the candidate’s mind thinking in the right area) (relatively simple answer/s required)
What could cause a flat anterior chamber on the first Wound leak
day following a trabeculectomy? Choroidal detachment
Malignant glaucoma
Default question Notes on answer
only ask if the candidate is having problems (very simple answer required)
with the first question – may not need to be asked)
Could there be a wound leak? Yes
Focus question Notes on answer
(to focus the trainee’s mind on to the specific aspect (usually straightforward answer/s)
of the area to be tested)
How would the level of intra-ocular pressure help to Low pressure – leak
establish the reason for the flat anterior chamber? High pressure – suggests malignant
glaucoma
Competence question Notes on answer
(must be carefully thought out and worded to allow (must include the
assessment of competence) important points for competency)
Describe exactly how you would manage a case of Medical – dilate pupil (must
malignant glaucoma. Demonstrate clear understanding of
the mechanisms involved)
Surgical – aspiration of aqueous, vitrectomy, reformation of A/C etc
Prevention of recurrence
Surgery on fellow eye
Escape question Notes on answer
(if answer is less than ideal – to end the topic, and allow a move to (very simple answer required)
another topic – may not need to be asked if answer is satisfactory)
Would dilating the pupil help? Yes 5
Examiner’s Comments
Competent (please circle) YES NO
Examiner’s signature:
Please note that this type of question is a guideline to both candidates & examiners. The examiners may wish to explore in further detail the candidates knowledge in responses to questions. 6
APPENDIX B Guidance Notes for Generic areas
A Consent
Introduction Check patient’s name, then give your name and position
Explain what you are doing and by what authority
Information Check what they already know about their condition and any possible surgery
Explain the diagnosis in simple terms
Explore how much they actually want to know
Explanation What exactly is the proposed action or operation?
What are the possible choices -including the consequences of doing nothing?
What are the likely short and long-term outcomes?
Is any alternative action likely during the procedure?
Mention all serious complications and those with an incidence > 1% (including
anaesthetic complications)
Management and likely prognosis if these complications do occur
Comprehension Has the patient understood your explanation?
If not, is there someone else who you should explain it to?
Has your explanation been adequate? -always ask “is there anything else you would like to ask?”
Case-notes Write down what was discussed and what was agreed
Sign the appropriate consent form