The Ophthalmology ST1 interview is one of the most competitive interviews in the country, with many excellent applicants and outstanding portfolios, so it’s important you prepare for it properly.
Here are some tips for your portfolio and the interview stations, which will hopefully optimise your application. We’ve also prepared a number of Ophthalmology ST1 Mock Interviews to help you prepare.
Ophthalmology ST1 Application
The overall ophthalmology application consists of your portfolio (50 marks), the MSRA exam (20 marks), and four interview stations (20 marks each). These 6 components add up to an overall score out of 150 and your score is used to work out your ranking compared to other candidates. You will need to score above a certain cut-off mark in the MRSA exam to be invited to interview.
Proportionally, the portfolio gives you the largest weighting, but it also takes years to get the points here for publications, research, a PhD or PACES.
Doing well in the MRSA exam and the interview, which is structured much like an OSCE exam, are marks that you can attain with targeted revision over just a few months.
Your portfolio is submitted to the panel of interviewers on the day of your interview, and is marked according to a set criteria divided into qualifications/prizes, commitment to ophthalmology (e.g. electives/taster weeks), publications, your best audit/QIP, presentations, and teaching.
The details are clearly listed on the Severn Deanery website: http://www.severndeanery.nhs.uk/recruitment/vacancies/show/ophth2018/portfolio-review-lib
Crucially, your portfolio should be clearly laid out, following the mark scheme to the letter, as you have no opportunity to explain or present your contents. A couple of interviewers will only have 20 minutes to flip through your life’s work, so it is vital that it is organised, and everything that is worth points is easily navigable and scored for your benefit. Everything that is unnecessary should be left out, as it detracts the interviewers attention. A thick folder is often not a good portfolio!
Note that you can score most points even with presentations/ publications/ audits etc. that are not ophthalmology themed, and that there is only one section that requires some ophthalmology related experience.
There are also a few ways to gain some last-minute marks if you haven’t already got them. For example, you can “design an educational course” via an e-learning tool which you can put together in your local hospital. Alternatively you could publish a series of blog posts on a medical topic of interest. In “commitment to ophthalmology”, if you haven’t already, you can ask your friendly local ophthalmologist if you can spend time with them in eye casualty (with a letter as evidence for points). There are also marks for the use of the EyeSi programme, which is a microsurgical simulator that junior trainees use, for example in training for independent cataract surgery. Only a few units such as Moorfields Eye Hospital, Western Eye Hospital and the Royal College of Ophthalmologists have this simulator, and the best way to access these is to ask a friendly ophthalmology trainee.
For more advice on how to structure your portfolio and how to use what you already have to maximize marks, check out this e-book on Amazon.
You can also read more about preparing your portfolio.
Multi-specialty Recruitment Assessment (MSRA)
This is a multiple-choice exam that is also taken by GP, radiology and other specialty applicants. It consists of a SJT-type component, and a general medical questions component. Details of the exam can be found on the Severn Deanery website: http://www.severndeanery.nhs.uk/recruitment/vacancies/show/ophth2018/sra-lib
The best advice for this is to do as much practice possible. It is not a difficult exam, but you need to do fairly well to to simply get an interview. Furthermore, the higher you score in this exam, the higher your overall interview score. The cut-off score for interview will vary from year to year.
Example question banks are:
Practice is especially important in the clinical component, and it can also be useful in your interview. It is usually based on generic, GP-tailored medical knowledge, which is a useful refresher for some basic interview questions.
There are 4 face-to-face interview stations on the day, with your portfolio going into a different room to be scored independently.
Before you start, you have 40 minutes preparation time where you are provided with:
- A paper to appraise, often without an abstract
- A clinical scenario usually with a picture eg. a fundus photo of diabetic retinopathy, with a few starting questions
- A hospital-based scenario with QIP-type questions
- A scenario with a patient, for the communication station.
You should spend up to 20 minutes on the paper, and the rest of the time on the other material. You may make short notes and bring them with you into the interview.
1. Critical appraisal
This is a station that you can practice for in advance, and there are many good books published on how to critically appraise a paper. A good source is Trisha Greenhalgh’s “How to read a paper.” Here is a BMJ version with articles written by her.
When preparing for interview, you can practice by reading multiples articles and appraising them within 20 minutes. A good method for summarising the paper in your mind and a structuring your critique is PICO (population, intervention, comparison, outcome). You can ask yourself questions on these 4 categories, looking for where the paper is lacking or has done well. Familiarise yourself with different types of evidence, common statistical methods and terms, and important concepts such as randomisation and bias. This website has some useful tools and definitions that will be helpful. It is very useful to have these example structures when appraising papers and we recommend practicing on at least 20-30 papers to get the hang of how to do this within the 20 minute timeframe.
During the interview, you have the paper with the notes you have made in front of you, so you may refer to it if necessary. There are usually some specific questions about the paper itself, such as why their control population was not ideal, or what was their number needed to treat. There are also usually some analytical questions such as whether this paper would change your clinical practice.
With adequate practice, this is one of the stations that you can score almost full marks in.
You are given a scenario to read in your preparation time that is usually about a particular problem in the hospital setting. For example, within the last month, there have been 10 post-cataract surgery endophthalmitis cases in your hospital (this should occur in <1/1000 cases). You are then expected to explain how you would go about organising a quality improvement project to address this.
These are some basic concepts to familiarise yourself with for this station:
- PDSA (Plan, do, study, act) cycle in QIP: what is the problem? What steps would you want to undertake to solve it? Who do you want to help you (pharmacists, ward manager, nurses, colleagues)? How do you show you have made an improvement?
- SMART objectives
- Datix reporting tool in your local hospital: you should know how to do this. You can datix any incident that compromises patient care. This will then be sent to the consultant lead and manager of that relevant department.
- Clinical governance
- CQC inspection
- MHRA – yellow card reporting
- What happens to patient complaints, how this is dealt with in your department?
3. Clinical station
This is usually based on a photo of a video that you saw in the preparation time. It often starts with basic questions asking you to describe what you see and what it might be. You will then get some general medical questions, before the questions get progressively more difficult, such as questions about landmark trials and statistics.
The best way to prepare for this is to familiarise yourself with presentation and management of the common sight threatening conditions that have any systemic implications.
A few basic themes are as follows (not exhaustive list!):
- Diabetes and diabetic retinopathy – you should at least know about the screening programme and its grading system, what the complications of proliferative diabetic complications are (vitreous haemorrhage from new vessels, tractional retinal detachment, macula oedema), and how it is treated (panretinal photocoagulation, anti-VEGF injections, steroid injection, systemic gycaemic control)
- Cranial nerve palsies (3rd, 4th, 6th) – how they present, what it might mean (CVA, aneurysm, medical vs surgical 3rd nerve palsy and how you differentiate this clinically)
- A swollen disc – how you determine and describe papilloedema, what this might mean in the brain, the need for imaging, how to diagnose IIH, how to treat this (refer to neurology, LP, oral acetazolamide)
- Retinal vein/artery occlusions – how you diagnose and describe this on the fundus photo, what are major risk factors, what is the visual prognosis (is it ischaemic or non-ischaemic vein occlusion), how to treat (if there is macula oedema), what is the blood supply to the retina
- Glaucoma – large worldwide disease burden, what is glaucoma and what are the main types of glaucoma (closed angle – emergency! Vs open angle chronic glaucoma), how to treat in an emergency.
- AMD – common condition in elderly white population, what risk factors, when dry AMD becomes “wet”, what is pathogenesis of “wet” AMD (choroidal neovascularization), how to treat.
The model answers in our mock interviews will give you an idea of the level you should be aiming for when answering these questions.
The application guide we mentioned earlier also has a section on various clinical scenarios that you can use for reference
But the best way to prepare is to be familiar with these common sight threatening conditions and other eye conditions with general medical implications such as myasthenia gravis, thyroid eye disease, ptosis and Horner’s syndrome.
4. Communication skills
This is a fairly generic skills station, with an (often very realistic!) actor, in an ophthalmology-based scenario.
Common themes are breaking bad news, dealing with an angry patient, explaining a difficult concept and dealing with a colleague’s mistake. These are skills that are not ophthalmology specific so you can practice them in any medical job.
- Get started as early as you can! Get your portfolio in order, it takes a lot longer then you expect.
- Read ALL official instructions carefully – http://www.severndeanery.nhs.uk/recruitment/vacancies/show/ophth2018
- Practice for the MRSA exam and do lots of questions
- Prepare for the actual interview like you would with 4 OSCE stations.
- Remember, you are scored stringently with a mark scheme, so although it is important to be polite and come across well, you need to say as many correct answers as possible to score the most points in a very short time
- Good luck!
You can read our other articles on the Ophthalmology ST1 Interview.