Medical ophthalmology is an holistic specialty which provides specific expertise in the diagnosis and medical treatment of people with disorders of vision.
More than 50% of new ophthalmic referrals present with a medical rather than surgical problem; hence medicine comprises a large proportion of the workload of any eye department.
Entry to medical ophthalmology training is from either core medical training or ophthalmology specialty training.
Medical ophthalmology - trainee characteristics
Trainee physicians with the skills detailed below will be suited to a training programme in medical ophthalmology:
-
good team-player skills, including skills in clinical leadership and change-management
-
flexibility, attention-to-detail and lateral thinking
-
excellent communication skills - both spoken and written
-
the ability to work (and enjoy working) under pressure.
Working in medical ophthalmology
The specialty
Medical ophthalmology is an emerging medical specialty in the United Kingdom. In the future it is expected there will be one ophthalmic physician (medical ophthalmologist) per population of 263,000.
The primary purpose of the specialty is the medical assessment, investigation, diagnosis and management of disorders affecting vision, particularly:
-
inflammatory disorders affecting vision (eg uveitis, scleritis, corneal graft rejection, systemic vasculitis
-
vascular disorders affecting vision (eg diabetes, arteriosclerosis, hypertension, stroke)
-
neurological disorders affecting vision (eg multiple sclerosis, stroke, pituitary disorders, thyroid eye disease)
-
public visual health (eg diabetic retinopathy screening).
Other important aspects include:
-
genetic disorders affecting vision (eg retinitis pigmentosa)
-
retina-specific disorders affecting vision (eg age-related macular degeneration)
-
visual rehabilitation (eg age-related macular degeneration)
-
ophthalmic procedures, particularly laser therapy for diabetic retinopathy, and local injection therapy for age-related macular degeneration.
Application of medicine in ophthalmology
Of the new referrals to ophthalmology that require intervention or specialist follow-up, 50% are medical in nature and benefit from the expertise of a clinician with expertise in internal medicine.
New medical treatments for eye disease, including the use of biological agents for inflammatory eye disease, have increased the demand for medical specialists in ophthalmology.
The Centre for Workforce Intelligence issued a report in 2014 recommending a staged increase in medical ophthalmology training posts to meet the growing requirement for medical care in ophthalmology.
Application of ophthalmology in medical specialties
Expertise in ophthalmic medicine is also appropriate for diabetes where the prevalence is expected to rise by 60% in the next decade as a consequence of the ageing population and the epidemic of obesity.
As the eye is a direct extension of the brain, then expertise in neurology is beneficial as many patients with visual disorders have conditions affecting the brain and its pathways rather than the eye itself.
The ophthalmic physician requires to have varied clinical skills beyond expertise in the assessment and diagnosis of visual symptoms and signs. He or she must have expertise in immunosuppression, neurology and cardiology.
In addition, many ophthalmic physicians will be involved in managing large diabetic retinopathy screening programmes, which require organisational and public health skills. Some will be required to manage retina-specific disorders requiring practical skills such as laser therapy and intra-ocular injections.
Benefits and workload
Ophthalmic medicine is a fascinating and rewarding specialty. It is predominantly out-patient based.
The workload of an ophthalmic physician is varied ranging from the personal delivery of care such as laser therapy for diabetic retinopathy through to the intellectual challenge of neuro-ophthalmic disorders. It is also very rewarding with the majority of conditions responsive to therapy. There are opportunities to specialize within medical ophthalmology and to combine clinical care with research or educational roles.
Medical Care
Find out more about medical ophthalmology and the services delivered by the specialty on Medical Care – the RCP’s online guide to service design.
Further information
Queries regarding the progress of a submitted application should be directed to the lead recruiter for this specialty. The lead recruiter for medical ophthalmology in round 1 2019 is London and KSS (LaKSS) Recruitment:
| London and KSS (LaKSS) Recruitment | ||||||
|---|---|---|---|---|---|---|
| ST3/general queries | General enquiries - Enquiry Form | |||||
| Fitness to practise/Disability/GIS queries - confidential | https://lasepgmdesupport.hee.nhs.uk/support/home | |||||
| Website | http://www.lpmde.ac.uk/laserecruitment/ | |||||
General / application queries
For general queries relating to areas such as eligibility criteria, making an application or the Oriel system, please contact the Specialty Recruitment Office via email at st3medrecruitment@hee.nhs.uk.
Eligibility for medical ophthalmology
Please be aware that the specialty also accepts applicants from ophthalmology training routes.
Non-physician applicants must have obtained the basic specialty professional examination (FRCOphth Part 1) in addition to specific clinical experience and competences to be eligible. Therefore applicants seeking a position in medical ophthalmology must have one of the following:
-
Physician training (eg CMT) - MRCP(UK) Part 1 at time of application; full MRCP(UK) by required deadline
-
Opthalmology training - FRCOphth Part 1 by required deadline
Please view the medical ophthalmology person specification for information about the examinations, experience and competency required for applying to the specialty from a non-physicianly training background and the deadlines for when this must be achieved.
Medical trainees please view the standard eligibility criteria as detailed in the am I eligible? section.
National single centre model
This specialty uses the single centre recruitment model.
You will not be required to give any preferences of particular regions when completing your application; you are applying purely for the specialty at that stage.
Later on, you will be required to give preferences of the available posts – at that point, you can opt to be considered for as many (or as few) post vacancies available nationally as you wish.
Lead region and single centre interviews
The specialty will nominate a particular region to act as lead for the round; this region is shown under the 'Who do I contact?' tab above. This lead region will review all applications, liaise with all candidates, host interviews, verify assessments, and make offers on behalf of all regions nationally.
Your application will be handled solely by the lead region throughout the entire round, up to the point where you receive and accept an offer; after which it will be transferred to the region where the post is based for pre-employment checks.
All interviews will be held at this lead region although the clinicians making up the interview panel will be drawn from a national background – ie not just from the host region.
It is possible that there could be changes between now and the interview period. Please bear this in mind when reviewing the information below, although in most cases it is not expected this will change, or any changes will be minimal. You are advised to check back in closer to the time of interview. The date at the foot of this page shows when the page was last reviewed.
Interview content
You will spend approximately 10 minutes at each of the three interview stations, with three-to-five minutes' transfer time between each. Thus the overall time for the interview will be approximately 40-45 minutes.
Click on the relevant stations below for more information on the content of the interview.
Please note that this is subject to change, and will be confirmed by the date of interview.
This is where your application form and training to date will be reviewed. This will include checking the documentation you have brought along to ensure all content on your application form is correct. You are required to give a presentation which you are expected to prepare in advance, on a given subject.
Presentaion
Upon arrival at the station 1, you will need to give a presentation on the following subject, for no more than four minutes :
'Why I am interested in a career in medical ophthalmology (opthalmic medicine), and the evidence I have to support my suitability and commitment to the specialty.'
Specific guidance on preparing your presentation is given below:
'Unfortunately we cannot always offer a training post to all candidates and therefore, thinking about the length of your career to date, and the experience you have gained since qualification; please convince us in the four minutes allocated that the experience and skills you have gained in that time suggest you are worthy of a training post; your presentation will be timed.'
No aids or external resources will be provided - there will be no projectors or laptops for PowerPoint, no OHPs, flip-charts, etc.
You are welcome to use prompts on small cards; but these should be for your own use only, and should not be given out as hand-outs.
When preparing your presentation, you should consider your career progression to date, achievements you have gained, examinations passed, comeptences, your portfolio, feedback received, etc.
Once your presentation is complete, your training, career to date and your suitability for the specialty will be discussed for a further six minutes.
Evidence checking
In addition, normally your evidence folder will have been reviewed by the interviewers immediately prior to your arrival in the station. They will be:
- Checking that your achievements in your evidence folder match that claimed on your application form.
- Considering your career progression to date.
- Identifying areas about which they may wish to question you during the interview.
Areas for assessment
The two main aspects of discussion here, on which you will be assessed, will be your suitability for and commitment to ST3 training in the specialty, and your achievements and engagement with training and learning to date .
Scoring at the station
It is important to recognise that the scores awarded to you at this station will not purely be about your achievements, as this already contributes towards the scoring via your application form. Interviewers will be deciding upon scores via a combination of factors, for example: your responses to the questions asked, the breadth and quality of your achievements as highlighted in your folder and presentation and your career progression.
Prior to arriving at station 2, you will be given a clinical scenario to review. Upon arrival at station 2, you will be asked questions relating to this scenario.
The clinical scenario will be relatively brief (two/three sentences), so once you have read this, the remainder of the pre-station time will allow you to undertake some short preparation (just mental preparation - this does not mean making notes, etc.)
Scenario considerations
The scenario will describe a hypothetical clinical situation which has arisen in which you are, or have become, involved.
There are some points you should consider when reviewing the scenario and preparing for discussion:
- what steps you would take
- any potential treatments possible
- any further information you would gather
- how you would go about communicating with any people (eg patients, family members, colleagues) involved in the scenario.
Of course, you should take into account any other factors you deem appropriate, using your experience and professional judgement.
Areas for assessment
One mark will be awarded to you based on your suggestions and responses to the clinical scenario.
The second assessment carried out here will be on the communication skills you display.
This will be both an assessment of how you would communicate with patients, colleagues, etc. in the scenario, as well as of how well you communicate with interviewers at the station.
[Please note - interview nerves will be taken into account!]
This station will feature assessment of an ethical scenario, and discussion of a question on the subject of professionalism & governance.
Ethical scenario
The first assessment area will be the ethical scenario. As with the clinical scenario at station 2, this takes the form of a hypothetical situation, described briefly in text form, details of which will be given to you before arriving at station 3.
However, as you would expect this scenario focuses less on a clinical situation, and deals more with consideration of the moral, ethical, legal (etc.) issues which may arise in a particular situation.
The first area of assessment at station 3 will be your suggested reponses to the ethical scenario during discussion here, as well as your knowledge of the different considerations required.
Professionalism & governance
Following the ethical scenario will be discussion of professionalism & governance.
This discussion will be prompted by a short question (often a single sentence) provided by interviewers. This will not be given to you before arriving at the station - this will be given verbally by interviewers once ethical scenario discussion is finished.
This section of the interview is designed to assess your demonstration and understanding of professionalism and governance in a given situation.
Familiarise yourself with Good Medical Practice
Please note - assessment at station 3 is underpinned by the principles of GMC Good Medical Practice.
Interview scoring
Appointable - automatic
If you are awarded a score of at least 3/5, for all marks given to you at your interview, then you will automatically be classed as appointable.
Not appointable - automatic
If any of the 12 scores awarded to you at interview are 1/5, this will reflect poor performance and an area of major concern.
If four or more of your 12 interview scores are of 2/5, this will reflect several areas of concern across your whole interview.
Should your interview assessment fall under either category above, the level of concern over your potential progression to ST3 will see your application classed automatically as not appointable.
Appointability subject to panel decision
In the event that your 12 interview scores contain one, two or three marks of 2/5 (and the rest 3/5 or above), your appointability status will be subject to discussion in the post-interview 'wash-up' meeting.
The clinicians who have interviewed you will discuss your general performance during the interview and any concerns or otherwise they have about your application as a whole.
Should they deem it appropriate, your application will be classed as appointable, and you can then be considered for post offers; whereas if they feel their concerns are too substantial for this outcome, they must class your application as not appointable, and it will progress no further in the current recruitment round.
Review vs automatic status
Please note there is no distinction made between candidates judged as appointable automatically, and those classed as appointable on review. Once deemed appointable it is only your overall score which will be used to determine ranking.
Total score calculation
After interview, a weighting is applied to the scores in each area, as well as the application form score, to give a 'total score'. This score determines your ranking which is used to inform how offers are made. The weighting of different sections, as well as the method by which your total score is established, can be seen by clicking on 'Total score calculation' below.
Please note that this is subject to change, and will be confirmed by the date of interview.
| Int. 1 | Int. 2 | Weighting | Max score | |
| Station 1 | ||||
| Evidence | / 5 | / 5 | x1.6 | / 16 |
| Suitability for specialty | / 5 | / 5 | x1.2 | / 12 |
| Station 2 | ||||
| Clinical scenario | / 5 | / 5 | x1.6 | / 16 |
| Communication mark | / 5 | / 5 | x0.8 | / 8 |
| Station 3 | ||||
| Ethical scenario | / 5 | / 5 | x1.6 | / 16 |
| Professionalism and governance | / 5 | / 5 | x1.2 | / 12 |
| Raw interview score | / 60 | |||
| Interview score (including weighting) | / 80 | |||
| Short-listing (app form) | / 80 | x0.25 | / 20 | |
| Overall assessment score | / 100 | |||
As part of the process of applying to ST3, you may wish to gain an idea of how recruitment progressed in previous years for the various specialties participating in the nationally-coordinated recruitment.
To this end, we have published data dating back to 2013 (where this is available), based around four main areas:
-
Competition ratios - application numbers submitted to each specialty, along with the number of NTN and LAT posts available in each. It is worth noting that posts are subject to change throughout the round (increasing on average between 20-40%), and post numbers for this data are taken at the end of the round.
-
Shortlist scores - the scores awarded to all submitted applications, including average scores and distribution nationally.
-
Total scores - the total score awarded to all candidates who completed the full recruitment process for a specialty (application and interview), including some analysis of scores.
-
Post fill rates - the number of posts filled by region.
We have published information for all specialties participating in our process that year; consequently not all specialties will have data in all cases.
Round 1
| Year | Apps. | NTN posts | LAT posts | Total posts | Comp. | Unique* |
|---|---|---|---|---|---|---|
| 2018 | 4 | 3 | 0 | 3 | 1.3 | 50% |
| 2017 | 10 | 4 | 0 | 4 | 2.5 | 70% |
| 2016 | 9 | 1 | 0 | 1 | 9.0 | 44% |
| 2015 | 9 | 5 | 0 | 5 | 1.8 | 44% |
* the percentage of unique candidates that only applied to this specialty (out of the 24 PSRO-coordinated specialties)
Medical ophthalmology has not participated in round 2 in these years.
Provisional post numbers
Specialty vacancy numbers are available in the table below, broken down by region and divided between substantive national training number (NTN) and locum appointment for training (LAT) posts.
It is the intention that initial post numbers for all regions will be published prior to the application opening date, although this cannot be guaranteed. Numbers will be updated as and when notifications are received from each region and will be checked later in the round when programme preferences are open for selection.
Numbers subject to change
Please be aware that it is not uncommon for vacancy numbers to change throughout the round.
More commonly, post vacancy numbers can increase as the round goes on (and confirmation of posts becomes available); but it is also possible that numbers can reduce as well. On average post numbers rise between 20-40% from the start to the finish of the round but this can vary greatly for individual specialty/region combinations.
It is possible that regions which do not have a post at the start of the round may declare one after applications have closed. Whilst we try and minimise instances of this, it is not always possible to predict vacancies so even if there appears not to be a vacancy in your preferred specialty/region combination, you may wish to consider applying in case one becomes available during the round; you can check with the region concerned if you wish to check on the likelihood of a post arising.
Generally, once a region enter a post into a round they would always have at least one post available and would only withdraw it in exceptional circumstances.
Round 1 Interview dates & post numbers
| Region | NTN posts | LAT posts* | Interview date(s) |
|---|---|---|---|
| East Midlands | 0 | n/a |
London (lead) |
| East of England | 1 | n/a | |
|
London and KSS (lead) |
Kent, Surrey & Sussex |
n/a | |
|
London |
n/a | ||
| North East | 0-1 | n/a | |
| North West |
Mersey |
n/a | |
|
North Western |
n/a | ||
| South West |
Peninsula |
n/a | |
|
Severn |
n/a | ||
| Thames Valley | TBC | n/a | |
| Wessex | TBC | n/a | |
| West Midlands | 0-2 | n/a | |
| Yorkshire & Humber | 0 | n/a | |
| Scotland** | 0-1 | TBC | |
| Wales | 0 | TBC |
*English LATs
Please note, English regions do not recruit to LAT posts.
**Scotland post numbers
If you are interested in working in Scotland, a breakdown of post numbers by the four Scottish deaneries is available on the Scottish Medical Training website. This has details of all specialty training post numbers in Scotland, including specialties which are not part of the nationally-coordinated process.
Please note that whilst we endeavour to keep the Physician ST3 recruitment website up to date, the SMT website will always be the more accurate one where they differ.