The Royal College of Ophthalmologists

Part 2 FRCOphth Examination

Candidates’ Information Pack

(Updated May 2014)

The Examination

The Part 2 FRCOphth is a synoptic exit examination that uses several different and complementary
assessment methods. Success in this examination allows a doctor to become a Fellow of the Royal
College of Ophthalmologists. It is a necessary but insufficient requirement for completion of specialty
training in the UK.

The examination is blueprinted against the General Medical Council’s (GMC) Good Medical Practice and
the detailed learning outcomes of the curriculum for Ophthalmic Specialist Training (OST), which has
been approved by the GMC.

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. Candidates are
required to pass this examination by the end of year seven of ophthalmic specialist training.

From 1 August 2014, candidates will be permitted a maximum of four attempts in which to pass the Part
2 FRCOphth Written Component and four attempts in which to pass the Part 2 FRCOphth Oral
Component. Examination attempts prior to August 2014 will be discounted.

The assessment methods selected for the Part 2 FRCOphth are:

Written Component:
• Single best answer from four multiple choice questions (MCQ)

Oral Component:
• Structured viva (SV)
• Objective structured clinical examination (OSCE)

From late 2014 the Part 2 FRCOphth Written Component will be held twice yearly in June and December.
The Part 2 FRCOphth Oral Component is held twice yearly in April and November..

The validity of a pass in the Part 2 FRCOphth Written Component will be limited to 7 calendar years.
Candidates who have not successfully completed the Part 2 FRCOphth Oral Component within this time
will be permitted to re-sit the written component on the proviso that they have not exhausted the
permitted four attempts at the written component and retain at least one attempt at the oral component.

Required Reading

Candidates should be familiar with the following documents

• The Ophthalmic Specialist Training Curriculum (http://curriculum.rcophth.ac.uk).

• The Part 2 FRCOphth Examination Syllabus, which is available in the Part 2 FRCOphth
Application Pack (www.rcophth.ac.uk/examinations )
• Good Medical Practice, GMC (http://www.gmc-uk.org/guidance/good_medical_practice.asp)
• Policy on allegations of cheating and misconduct, which is available under ‘Admissions to
Examinations (www.rcophth.ac.uk/examinations )

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Part 2 FRCOphth Written Component

The Part 2 FRCOphth Written Component consists of 180, single best answer from four, multiple choice
questions (MCQ). For logistical reasons, the written examination is sat in two halves of 90 MCQ,
each lasting two hours. The total examination time is four hours. There is no negative marking.

The blueprint for the written examination is detailed below. The numbers provided for each sub category
(e.g. Glaucoma – 10 MCQ; Cataract – 10 MCQ) are an approximation for illustrative purposes.

Total
Number of Approximation
Blueprint Topic MCQ Sub-category of MCQ
Clinical Ophthalmology 128 Trauma 4
Plastics / Orbit 10
Glaucoma 10
Strabismus / Paediatrics 16
Retina (Medical & Surgical) 20
Cataract 10
Cornea / External 20
Uveitis / Oncology 12
Neurology 16
Medicine 10
Pharmacology/Therapeutics 12 12
Investigations 16 Ophthalmic 9
Orthoptic 3
Neuro-imaging 3
Other 1
Miscellaneous 16 Statistics/Epidemiology 3
Research/ EBM 3
Nutrition 1
Ethics / Driving 4
Economics 1
Guidelines / Standards 4
Basic science 8 Anatomy/Physiology 2
Pathology 2
Genetics 3
Optics 1
TOTAL 180 180

Example MCQ:

Laser trabeculoplasty is MOST likely to be effective in an eye with which of the following?

a) Angle recession glaucoma

b) Posner Schlossman glaucoma (inflammatory glaucoma)
c) Pseudo-exfoliative glaucoma
d) Reigers syndrome.

Correct Response – C

Standard Setting for the MCQ

The pass mark for the MCQ paper will be set by a panel of examiners using Ebel’s method prior to the
examination.

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Part 2 FRCOphth Oral Component

Structured Viva

Introduction

The Structured Viva consists of a series of strictly timed assessment ‘stations’, where various areas of
competence are tested by examiners using an objective marking scheme.

Format of the Structured Viva

The Structured Viva will consist of a series of five stations, each of which will be timed for precise
periods of 10 minutes. Station 7 of the OSCE, Communication Skills, will not be conducted in a clinical
setting and will be held at the same time as the Structured Viva, lasting for a precise period of 10
minutes.

The stations are set out as follows:

Station 1: Patient investigations and data interpretation

Station 2: Patient management 1

Station 3: Patient management 2

Station 4: Attitudes, ethics and responsibilities

Station 5: Audit, research and evidence based practice and

Health promotion and disease prevention

Two examiners will be present at each station for the duration of the cycle.

The start and finish of each station is controlled by a timekeeper and clearly signalled.

Conduct of the Structured Viva

The timekeeper will announce the commencement of the station and the candidate will enter. The
examiners will begin the questions, following pre-agreed questions to ensure the same information is
requested of each candidate. At the end of the 10 minute session the timekeeper will signal the end of
the station. However it is possible that the structured questions may have been completed prior
to the end of allotted time. Under these circumstances the viva will terminate ahead of schedule
and the candidate will be informed that that viva station is complete and will be asked to leave
that station. The candidate should then wait outside that station until asked to move on by the
timekeeper. The candidate will leave the station and be directed to the next station. 5 minutes will be
allowed for changeover and for examiners to independently complete the mark sheet. The examiners are
requested to avoid giving signals suggesting a correct or incorrect answer.

Station 1: Patient investigations and data interpretation

Case-based discussion may include (but not be restricted to) the following:

• Interpretation of biometry
• Ocular and neuro-imaging
• Hess charts
• Electrophysiology
• Working with uncertainty

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Stations 2 & 3: Patient management 1 & 2

Case-based discussion may involve cases which are infrequently seen but essential to manage by all
ophthalmologists and unlikely to be represented in the OSCE examination. It may include (but not be
restricted to) the following:

• Endophthalmitis
• Ocular Trauma
• Intraocular and orbital neoplasia
• Emergency presentations (e.g. neurological, ophthalmic and those requiring medical referral)
• Complex cases

Station 4: Attitudes, ethics and responsibilities*

Case-based discussion may include (but not be restricted to) the following:

• Suspected child abuse

• Medical ethics
• Consent
• Confidentiality
• Duties of a doctor
• Appraisal and revalidation
• Management of complaints
• Critical incident reporting
• Poor performance in a colleague

Station 5: Audit, research and evidence based practice* and

Health promotion and disease prevention

Case-based discussion may include (but not be restricted to) the following:

Audit, research and evidence based practice

• Principles of audit and research

• Use of published evidence
• Published clinical guidelines

Health promotion and disease prevention

• Screening for ophthalmic disease

• Prevention of cross infection
• Hospital acquired infection
• Drug side effects

* Candidates are advised to read and make themselves familiar with:

• NICE Guidelines
• College Guidelines
• GMC documents e.g. Good Doctors Safer Patients, Revalidation, Good Medical Practice etc
• DVLA
• Strategic papers
• In some instances candidates may receive advance notification asking them to read a particular
paper for discussion at the forthcoming examination

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 Timetable

An example of the timetable for a cycle of the examination is set out below. The Communication Skills
OSCE station is conducted at the same time as the Structured Vivas for logistical reasons.

Examiners Examiners Examiner Examiners Examiners Examiners

A&B C&D s E&F G&H I&J K&L
Station 1 Station 2 Station 3 Station 4 Station 5 Station 6
(Communication
Skills
10 MINS 09.00-09.10 Candidate 1 Candidate 2 Candidate 3 Candidate 4 Candidate 5 Candidate 6
5 MINUTE INTERVAL
10 MINS 09.15-09.25 Candidate 6 Candidate 1 Candidate 2 Candidate 3 Candidate 4 Candidate 5
5 MINUTE INTERVAL
10 MINS 09.30–09.40 Candidate 5 Candidate 6 Candidate 1 Candidate 2 Candidate 3 Candidate 4
5 MINUTE INTERVAL
10 MINS 09.45-09.55 Candidate 4 Candidate 5 Candidate 6 Candidate 1 Candidate 2 Candidate 3
5 MINUTE INTERVAL
10 MINS 10.00-10.10 Candidate 3 Candidate 4 Candidate 5 Candidate 6 Candidate 1 Candidate 2
5 MINUTE INTERVAL
10 MINS 10.15-10.25 Candidate 2 Candidate 3 Candidate 4 Candidate 5 Candidate 6 Candidate 1

At each station, the examiner should remind the candidate of the time available and the signals used to
indicate the timing. It is vital that the timing of the station is strictly adhered to.

Method of Assessment for the Structured Viva

The mark sheets

10 marksheets, in total, will be completed for each candidate by the examiners i.e. two examiners per
station, 5 stations. Each structured viva is divided into four marking sections to be judged on a 4 point
Likert scale as follows:

Poor Good

0 1 2 3

Marking guidance for each Viva section is included for examiners within the structured question. Each
examiner will therefore award up to 12 marks per viva station, with each mark counting towards the final
overall score. The maximum total score for the Structured Viva exam is therefore 120.

For all candidates – whether pass or fail – detailed notes will be made on the reverse of the mark sheet
so that constructive feedback can be forwarded to the candidate including the type of cases and
questions asked. This feedback will be given as “satisfactory performance” and “unsatisfactory
performance”. Both examiners score the candidate independently.

Standard Setting for the Structured Viva

For each station, in addition to a numerical score, candidates receive a global score of pass, borderline
or fail used only to identify the pass mark for the Structured Viva using the borderline group method.

Red Flags

Candidates whose performance in any viva station has given the examiners cause for concern e.g.
indicated unsafe practice, will alert the Senior Examiner by way of a ‘red flag’ on the marksheet. The
cause for concern must be documented clearly on the marksheet. Candidates receiving a red flag
should reflect that their practice has been deemed particularly poor by the examiner/s and should
discuss this with their Educational Supervisor.

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Objective structured clinical examination (OSCE)

Introduction

The OSCE consists of a series of strictly timed assessment ‘stations’, where various areas of
competence are tested by examiners using an objective marking scheme.

Structure of the OSCE

The OSCE consists of 5 stations each timed for a precise period of 20 minutes. Station 6,
Communication Skills, will not be conducted in a clinical setting and will be held at the same time as the
Structured Viva, lasting for a precise period of 10 minutes.

The stations are set out as follows:

Station 1: Anterior segment

Station 2: Glaucoma and lid

Station 3: Posterior segment

Station 4: Strabismus and orbit

Station 5: Neuro-ophthalmology

Station 6: Communication Skills (takes place logistically with Viva aspect of the exam)

The subject matter is to be viewed as a guide. Patients may be presented in any station, and a degree of
overlap is expected to occur.

Two examiners will be present at each station for the duration of the cycle. In station 6, an
ophthalmologist is paired with a trained lay examiner. Other than the communications skills station, the
examination will take the form of short cases.

The candidate will be examined on three patients at each station.

The start and finish of each station is controlled by a timekeeper and clearly signalled. For the
Communication Skills station the timekeeper will indicate when there are two minutes remaining.

Conduct of the OSCE

The timekeeper will announce the commencement of the station. The candidate will remain standing
beside the station. One examiner will take the candidate to the station and instruct the candidate on the
task required for the first patient. This should involve giving the candidate a brief clinical scenario/history
and asking the candidate to examine the patient appropriately. After examination of the patient, the
candidate will be asked to describe his/her findings and there will follow a short discussion on the
investigation and management of the clinical problem. The second examiner should take the candidate
to the second patient and ask the candidate to examine them. This will be repeated, as appropriate, for
the number of patients in the station. Candidates should be careful to undertake appropriate hand
hygiene during the examination. Candidates need to be aware that because of time constraints, they
may be asked to terminate their examination to move onto the questions.

It is also technically possible for the examiners to complete their questions in advance of the allotted time.
If this is the case the candidate will be asked to leave the room. This is not to be taken as a particularly
good or bad sign.

At the end of allotted time, the timekeeper will signal the end of the station. The candidate will leave the
station and be directed to the next station. Time is scheduled to allow for changeover and for examiners
to independently complete the mark sheets.

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Equipment

The host centre are responsible for providing appropriate large items of equipment, such as slit lamps,
couches, indirect ophthalmoscope and distance fixation targets. Candidates are advised to consider
bringing items of equipment with which they are familiar. These might include (but are not restricted to)
direct ophthalmoscope, occluder (with ruler), pen torch, near fixation target, hat pins (for fields) and
condensing lens for slit lamp fundus examination.

Station 1: Anterior segment

The candidate will be examined on three cases.

Skills to be tested may include (but not be restricted to) the assessment, interpretation, diagnosis and
management of:

• Abnormal lid position (ectropion, entropion, ptosis, trichiasis, lagophthalmos and exposure)
• Abnormal lid swelling (chalazion, benign and malignant tumours)
• Blepharitis
• Epiphora
• Infectious external eye disease including conjunctivitis and keratitis
• Dry eye
• Cicatricial conjunctival disease
• Corneal and conjunctival degenerations
• Peripheral ulcerative keratitis
• Corneal dystrophies
• Allergic and atopic disease
• Complications of contact lens wear
• Corneal oedema, opacity, ectasia, corneal transplantation and corneal graft rejection and other
complications
• Episcleritis, scleritis
• Peripheral ulcerative keratitis
• Conjunctival and anterior uveal tumours
• Aniridia and other dysgenesis
• Anterior uveitis
• Anterior segment injury
• Lens dislocation
• Assessment, diagnosis and management of all forms of cataract and the complication of cataract
surgery
• Diagnosis and management of associated medical conditions
• Genetic diseases affecting the anterior segment

In this section candidates must be proficient in the use of the slit lamp microscope in examining the
anterior segment employing direct and indirect illumination, retro-illumination, specular reflection and
scleral scatter as appropriate to best demonstrate signs.

Station 2: Glaucoma and lid

The candidate will be examined on three cases.

Skills to be tested may include (but not be restricted to) the assessment, interpretation, diagnosis and
management of:

• Ocular hypertension and all forms of glaucoma and its management, including the use of
hypotensive agents and glaucoma drainage surgery and its complications
• Ocular hypotension following glaucoma surgery and its management
• Abnormal lid position (ectropion, entropion, ptosis, trichiasis, lagophthalmos and exposure)
• Abnormal lid swelling (chalazion, benign and malignant tumours)
• Blepharitis
• Diagnosis and management of associated medical conditions
• Genetic diseases associated with glaucoma and lids

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Station 3: Posterior segment

The candidate will be examined on three cases.

Skills to be tested may (but not be restricted to) include the assessment, interpretation, diagnosis and
management of:

• Vitreous disorders
• Retinal detachment
• Retinoschisis
• Degenerative retinal disorders
• Choroidal disorders
• Macular disorders
• Intraocular tumours (primary and secondary)
• Injury involving the posterior segment
• Retinal disease including inflammatory and vascular disorders
• Diagnosis and management of associated medical conditions
• Genetic diseases affecting the retina

Candidates must be proficient in the examination of the posterior segment and including the use of the
direct ophthalmoscope, indirect ophthalmoscope (indentation to be avoided) and slit lamp lenses.

Station 4: Strabismus and orbit

The candidate will be examined on three cases.

Skills to be tested may include (but not be restricted to) the assessment, diagnosis and management of:

• Concomitant strabismus
• Amblyopia and disorders of binocular vision
• Incomitant strabismus
• Nystagmus
• Ocular motility syndromes (e.g. Duane’s, Brown’s)
• Ocular myopathies
• Supranuclear eye movement disorders
• Abnormalities of eye movements including saccades and pursuit
• Neuromuscular disease
• Orbital swelling, exophthalmos, orbital masses, thyroid eye disease
• Diagnosis and management of associated medical conditions

Candidates should be proficient in eye movement evaluation and cover test (including alternate
cover and prism cover test) and methods of examining orbital disease.

Stations 5: Neuro-ophthalmology

Skills to be tested may include (but not be restricted to) the assessment, interpretation, diagnosis and
management of:

Neuro-ophthalmology

• Visual pathway disorders including optic nerve disorders

• Visual field loss secondary to disorders of the visual pathway
• Field testing using confrontation techniques
• Cranial nerve abnormalities
• Pupil abnormalities
• Abnormalities of eye movements including saccades and pursuit
• Disorders of the extrapyramidal system
• Headache
• Ocular myopathes

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 • Nystagmus
• Incomitant strabismus
• Supranuclear disorders of eye movements
• Neuromuscular disease

Candidates should be proficient in assessment of cranial nerves, pupils, the assessment of visual fields
by confrontation and coordination/cerebellar function. Candidates may be asked to examine a fundus or
optic disc using a direct ophthalmoscope during the neuro-ophthalmology station.

Station 6: Communication Skills (one ophthalmologist examiner and one lay examiner)

This station will take place within the Structured Viva component of the exam for logistical
reasons.

The Communications Skills station involves an interaction with one simulated patient and is worth half
the marks of Stations 1-5. The station is assessed by an ophthalmologist and a trained lay examiner.
The candidate will receive a GP letter or case scenario to read. The candidate may make notes on the
paper provided, which will be destroyed afterwards and not used for assessment. The timekeeper will
announce commencement of the station. The interview will last for a 10 minute duration and involve
interaction between the candidate and the patient/subject and may include history taking, taking consent
for surgery, some form of counselling or advising patients. The interview will commonly take the
following format:
• being given a brief background to the patient, a GP letter or an optometrist report to read
• taking a relevant history
• being presented with the findings of examination or investigation
• counselling the patient
• alternatively, a scenario may be suggested, e.g. a patient complaining about their treatment

History taking skills includes eliciting the presenting complaint systematically, enquiring about past
medical history, family/smoking/alcohol treatment history. The candidate should be able to follow
relevant leads and use appropriate verbal and non-verbal responses. There should be a good balance of
open and closed questions and the interview should be conducted at an appropriate pace, without
rushing or interrupting the subject inappropriately but covering the main aspects. The candidate should
be able to interpret the history and discuss the implications of the patient’s main problem.

Communication skills: The candidate introduces himself or herself to the subject and explains their role
clearly. They should put the subject at ease and establish a good rapport, exploring their concerns,
feelings and expectations – while demonstrating empathy, respect and a non-judgemental attitude. The
candidate should be able to provide clear explanations, free of jargon, which the patient/subject
understands. They should be able to summarise the interview and check the patient understands of the
discussion.

It is vital that the information given to the patient is accurate and appropriate. This is an important aspect
of this assessment. Candidates will be informed by the timekeeper when there are two minutes
remaining in order to appropriately conclude the consultation.

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Timetable

An example of the timetable for a cycle of the examination is set out below.

Examiners Examiners Examiners Examiners Examiners

Time A&B C&D E&F G&H I&J
Station 1 Station 2 Station 3 Station 4 Station 5
0900-0920 1 2 3 4 5
0920-0925 Rotation break & marking
0925-0945 5 1 2 3 4
0945-0950 Rotation break & marking
0950-1010 4 5 1 2 3
1010-1015 Rotation break & marking
1015-1035 3 4 5 1 2
1035-1040 Rotation break & marking
1040-1100 2 3 4 5 1
1100-1105 Rotation break & marking

At each station, the examiner should remind the candidate of the time available and the signals used to
indicate the timing. It is vital that the timing of the station is strictly adhered to.

OSCE – Method of Assessment

The mark sheets

12 mark sheets in total will be completed for each candidate by the examiners i.e. two examiners per
station, 6 stations. Each aspect of the OSCE station is judged on 4 point a Likert scale as follows:

Poor Good

0 1 2 3

For stations 1-5 examiners are asked to reach a judgment for both of the following elements:

• Examination
• Diagnosis and Management

For station 6 the examiners are asked to reach a judgement for each of the following elements:

Lay Examiner:
• Establishment of Rapport and Information Gathering
• Understanding of Information Given
• Patient Input re Overall Communication Skills
Ophthalmologist Examiner:
• Establishment of Rapport and Information Gathering
• Information delivery
• Appropriateness of Advice and Accuracy of Information

This will generate 2 marks per element per patient. Stations 1-5 are equally weighted with a maximum
of 18 marks available per examiner, per station. A maximum of 9 marks per examiner are available for
Station 6, Communications Skills. The maximum total score for the OSCE is therefore 198. All marks
count towards the final overall score.

For all candidates – whether pass or fail – detailed notes will be made on the reverse of the mark sheet
so that constructive feedback can be forwarded to you. This feedback will be given as “positive
performance” and “negative performance”, although the examiners are free to provide feedback using
other titles.

Both examiners score the candidate independently.

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Standard Setting for the OSCE

For each station, in addition to a numerical score, candidates receive a global score of pass, borderline
or fail. This is used only to identity the pass mark for the OSCE (for the whole exam) using the borderline
group method.

Red Flags

Candidates, whose performance in any OSCE station has given the examiners cause for concern e.g.
indicated unsafe practice, will alert the Senior Examiner by way of a ‘red flag’ on the marksheet. The
cause for concern must be documented clearly on the marksheet. Candidates receiving a red flag
should reflect that their practice has been deemed particularly poor by the examiner/s and should
discuss this with their Educational Supervisor.

Important Note:
Aggressive or inconsiderate behaviour, physical or verbal, to a patient will invariably result in a
red flag.

Part 2 FRCOphth Written Result

To pass the Part 2 FRCOphth Written Component, candidates are required to achieve the pass
mark plus one standard error of measurement (SEM),

Part 2 FRCOphth Oral Result

To pass the Part 2 FRCOphth Oral Component, candidates are required to pass both the Structured
Viva and OSCE sections. Candidates must re-sit the entire oral component, even if a pass was
previously achieved in any section.

Cross Compensation

If a candidate marginally fails the Structured Viva, their total marks for both the Viva and the OSCE will
be added together. If this mark exceeds the combined pass marks for both components, they will be
allowed to pass the examination. It is NOT possible to compensate a poor OSCE with a good viva
result.

Notification of Results

The results of the Part 2 FRCOphth Written Component will be dispatched by post two weeks after the
day of examination.

The results of the Part 2 FRCOphth Oral Component will usually be released four weeks after the final
day of examinations. Final results will be sent to candidates by first class post and the pass list will be
displayed on the College website. Candidates are not permitted to telephone the College for examination
results.

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Counselling

The College places great importance on providing guidance to those candidates whose performance
failed to meet the standard to pass the examination. For the Part 2 FRCOphth Written Component
candidates will receive the percentage of questions correctly answers per blueprint category. For the
Part 2 FRCOphth Oral Component, examiners are asked to provide notes to assist in this process,
particularly if there is concern regarding a candidate’s conduct during the examination (e.g. if the clinical
method of the candidate was rough or caused patient discomfort). All candidates will receive details of
their performance for formative purposes. It is intended that this is for personal information and that the
candidate should only share this with his/her educational supervisor. Candidates receiving a red flag
should reflect that their practice has been deemed particularly poor by the examiner/s and should
discuss this with their Educational Supervisor.

Appeals

A copy of the College’s Appeals Procedure is available online at www.rcophth.ac.uk/examappeal. The

sole grounds for appeal are:

• There is evidence of a procedural irregularity in the conduct or content of the Examination or

Assessment (including administrative error) which has adversely affected the candidate’s
performance
OR
• There were exceptional circumstances which adversely affected the candidate’s performance in
the Examination or Assessment

The College will endeavour to deal with exceptional circumstances fairly and consistently. Please note
that candidates presenting for an examination are thereby deemed to be fit and healthy to do so. Please
note, appeals will not be accepted on the grounds that a candidate considers his/her effort were under-
marked, that the candidate did not understand or was unaware of the Examination or Assessment
Regulations or because the candidate seeks to question professional or academic judgement.

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