The purpose of the examination is the assessment of clinical examination technique and management.

There are 3 sections including Clinical Refraction, an Objective Structured Clinical Examination
(OSCE) with management and a Viva section.

Failure of any section will require the failed section to be repeated.

SECTION 1
Clinical Refraction examination

Guide for candidates and examiners- (This section may change in the future and become an OSCE
station).

For the next diet of part B the clinical refraction examination will consist of refraction of one patient for 30 minutes, observed by two examiners. The examiners will score clinical technique and the accuracy of refraction measurements. The standard of the examination is competence to perform a satisfactory clinical refraction and prescribe glasses that the patient will find satisfactory. The examiners will independently give a final mark of “competent” or “not competent”. The final mark will be agreed by the 2 examiners. If there is a disagreement between the 2 examiners the lead examiner will make the final decision after consultation with the 2 examiners involved.

The components of the refraction examination are:

• History – a brief refractive history, and assessment of the patient’s refractive needs.
• Visual acuity – unaided and with a pinhole.
• Measurement of Interpupillary distance.
• Retinoscopy – Ability to perform a retinoscopy examination competently using techniques such as use of the fogging method or non accommodating target, correct use of a trial frame and
  knowledge of the candidate’s normal working
• Distance – An accurate sphere and cylinder result should be obtained.
• Subjective refraction – Ability to subjectively refine spherical and cylindrical correction, using the Jackson’s cross cylinder test and the Duochrome test.

Guidance on the minimum pass standard.

• Retinoscopy – ability to competently perform a retinoscopy examination and write the retinoscopy result with an approximate accuracy of sphere within one dioptre, cylinder within one dioptre and axis within 20 degrees. The standard will be modified depending on the level of difficulty of the test subject. A trial frame should normally be used. Where appropriate the fogging method should be used. Positive or negative cylinders may be used.
• Subjective refraction – satisfactory technique for refining the spherical power, the cylinder power and the cylinder axis should be demonstrated. Positive or negative cylinders may be used.

Techniques such as the Jackson’s cross cylinder test and the Duochrome test should be used.
The refraction result should be written with an approximate accuracy of sphere within one dioptre,
cylinder within one dioptre and axis within 20 degrees. The standard will be modified depending
on the level of difficulty of the test subjects. The refraction result should normally produce a Best Corrected Visual Acuity of no more than one line less than the known BCVA of the subject. The
standard will be modified depending on the level of difficulty of the test subject.

Please go to Optics and Refraction Course and register again.

Once you have finished the first lesson, send us your views.

SECTION 2
This section is a viva in 4 subjects

• Principles of good medical practice
• Clinical ophthalmology
• Ocular pathology
• Medicine and neurology in relation to ophthalmology

Failure in a viva will require only the failed viva to be repeated.

SECTION 3

Objective Structured Clinical Examination including clinical management (OSCE).
Guide for candidates and examiners.

The OSCE will consist of 3 OSCE sections and each station is observed by two examiners. The
examiners will score clinical examination technique and management of the clinical cases. The
examiners will independently give a final mark of “competent” or “not competent”. The standard of the examination is competence to perform a satisfactory clinical examination, detect significant clinical abnormalities and consider a differential diagnosis with management which is appropriate for the experience required at this level. The OSCE stations are modular and candidates failing in one section will have to resit only the failed section.

There will be 3 stations.

Section i ANTERIOR SEGMENT – 20 minutes duration. Please beware that all optical aspects of the slit lamp must be understood.
Slit lamp examination techniques. Examination of adnexal tissue & Anterior Segment including all
corneal layers. Anterior Chamber depth measurement & activity. Iris examination including
retroillumination. Principles of gonioscopy. Examination of lens and anterior vitreous.
Examples of cases include lid disease, corneal problems, cataract and glaucoma

Note – lids will not be everted and contact tonometry or gonioscopy will not be necessary.

Section ii POSTERIOR SEGMENT – 20 minutes duration. All patients will be dilated
Slit lamp biomicroscopy of the retina using 78D, 90D or superfield lens etc for posterior pole
examination.

Binocular Indirect Ophthalmoscopy – using 20D lens for the peripheral retina- patients may be seated and may not be lying down. Scleral indentation will not be required.
Direct Ophthalmoscopy for posterior pole examination may be required.
Examples of retinal conditions include macular disease, optic nerve head changes (not glaucoma),
peripheral retinal changes.

Section iii NEURO- OPHTHALMOLOGY & MEDICINE RELATED TO OPHTHALMOLOGY
– 20 minutes duration
Visual fields to confrontation – A number of techniques are acceptable Pupils – observation, direct/consensual, RAPD & near reflex.

Cover test/ Ocular motility- Hirschberg test cover/uncover & alternate cover test followed by motility in all positions of gaze including pursuit, vergences & saccades.

Cranial nerve examination. Specifically cranial nerves Vth, VIIth & VIIIth but the candidate must be a competent in testing all the cranial nerves.

Examples of cases include, cranial nerve palsy, stroke, pupil changes, general medical conditions
which routinely present to Ophthalmologists. Candidates may be asked to perform a neurological
examination, a cardiovascular examination and assessment of a thyroid case.

The standard is of timely, confident, competent clinical examination technique that demonstrates
considerable experience in performing the technique, and accurate, confident detection of clinical
abnormalities and management. Good communication skills with patients will be needed in order to
achieve this. The examiners will independently give a final mark of “competent” or “not competent” for each station. The final mark will be agreed by the 2 examiners. If the there is disagreement of the final mark the lead examiner will make the final decision after consultation with the 2 examiners involved.

Competency must be gained in all the sections to gain an overall pass for part B FRCS
(Ophthalmology).

An overall pass will lead to being conferred the MRCS Ed

After you register, you will get your lessons.

To receive the lessons, please and a mail to: profpmuthusamy@gmail.com