Mohammed Talha Bashir
Foundation Year 2 Doctor, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
Introduction
Ophthalmic specialist training (OST) is one of the most competitive training programmes in the United Kingdom with only 89 places for over 600 applicants in 2021 (1). The cancellation of face-to-face interviews in response to the Covid-19 pandemic is one of several changes effected by the Royal College of Ophthalmologists and the Severn Deanery which is the lead recruiter for the speciality.
Many budding ophthalmologists have struggled to adapt to the changes directly and indirectly imposed by the pandemic and were not successful in securing a training post during this time. The following article aims to outline changes to the OST application experience during the Covid-19 era and offers advice to those hoping to apply in coming cycles.
The Application Process
Applications are made up of three sequential assessments including a professional portfolio, an exam and an interview, and this general structure has not changed (2). First, a portfolio is submitted through a central recruitment system, Oriel and is scored over several domains including commitment to specialty, research, and teaching (2).
Next is the Multi-Speciality Recruitment Assessment (MRSA) which is an almost three-hour exam used in applications for several specialties which offer “run-through” specialist training (3). It includes two sections; the former assesses general medical knowledge, and the latter evaluates decision making in various professional contexts, much like the situational judgement test UK graduates sit in their last year of undergraduate medical training. Applicants who score above a cut-off are then invited to an interview. Those with the highest cumulative scores are ranked and offered jobs respectively.
Prior to the pandemic, the portfolio, MSRA and interview comprised 33%, 13% and 53% of an applicant’s total score respectively and now make up 50%, 20% and 30%. Specific changes to each section and the impact these have had on candidates are explored below.
Changes to the Application
The Portfolio
The weight of the portfolio has increased from 33% to 50% of the total application. While there has been little direct structural change to this section, many candidates have had difficulties securing points in several domains amidst pandemic regulations.
Publications (5 Points)
The most marked change to the portfolio is the publication section which, previously contributing 10 points, now carries half the weight. Students and foundation doctors had difficulty carrying out research as protected academic time was widely cancelled, and many ongoing projects could not be completed under new social distancing measures. However, there has been a massive increase in academic output from the scientific community at large during the Covid-19 era. Some candidates have sought novel research opportunities with many having success carrying out Covid-19 related observational studies (4).
Presentations (6 Points)
While many scientific meetings were postponed or cancelled in the first wave on the pandemic, the emergence of online conferences has made obtaining national and international presentations easier and more economical. Recently, in person and meetings have returned with many, such as the Royal College of Ophthalmologists Annual Congress, now offering online attendance in a hybrid format. As before, those taking advantage of novel research opportunities have had success in securing these points.
Ophthalmology specialty links and commitment to date as a career (12 Points)
The weightiest section in the portfolio has seen no official change from recruiting bodies, however candidates faced difficulties scoring in this section under social distancing regulations. Non-essential access to EyeSi surgical simulators was limited, and many attachments, taster weeks and student electives were cancelled preventing students and doctors from being able to secure some of the easier points. These regulations have now been lifted and current candidates are free to carry these out as before. Many ophthalmology courses and conferences, while initially postponed or cancelled, can now be attended digitally facilitating easier attendance at an often-reduced rate.
Education and teaching (5 points)
Mainstream opportunities to teach and examine students were lost during the first phase of the pandemic as in-person teaching, and many university exams were cancelled. However, many groups took advantage of the increasing use of online platforms like Zoom and Microsoft Teams and carried out large-scale online educational courses attracting hundreds of attendees nationally and internationally. As with ophthalmology courses, candidates can gain points attending one of many teach the teacher courses which have returned to both virtual, and in-person platforms.
The Multi-Specialty Recruitment Assessment (MSRA)
The only change to the structure of the MSRA since the start of the pandemic is that the exam can now be carried out in an online proctored environment for individuals who are shielding. An increasing cut off score of 525 in the last application cycle meant a significant number of applicants, many of whom had strong portfolios, were not invited to interview. The exam now comprises 20% of an applicant’s score, this increased weightage is a trend across training programmes nationally and has been criticised as it favours applicants with good general knowledge over those who have a deeper understanding in their chosen specialty (5). There is no indication that this weight will be decreased in coming application cycles and applicants are encouraged to start revising for this exam early in order to maximise their score.
The Interview
The most notable change to applications is the interview which is now conducted online instead of in-person, and only has one station which assesses communication skills. Previously, the interview comprised four, face-to-face stations assessing critical appraisal, clinical knowledge, quality improvement and communication. The rationale behind this change has been discussed on the ‘Eye to Eye’ podcast where Mrs Sarah Maling, the ophthalmology recruitment lead, explains that other domains could be assessed in the portfolio section, whereas communication could only accurately be evaluated in an interview setting (6). As interviews are now shorter, they are weighted less heavily and currently comprise 30% of the total score. This means that applicants will have to spend more time developing their portfolios and scoring well in the MSRA in order to maximise their chances. Although online consultations are becoming the norm in the NHS, many applicants still have limited experience in online interviews which can heighten anxiety (7). Crabtree (2021) has written guidance on how to prepare for the interview highlighting important considerations one should make (8).
Conclusion
OST continues to be one of the most competitive training programmes in the UK. The overhaul of the application process, and restrictions imposed second to the Covid-19 pandemic have left many strong candidates struggling to secure a place.
Considering these changes, and after examining work done by successful applicants, we advise the following 5 points for those looking to apply in order to maximise chances of success in coming cycles.
1) Understand the Application Process
Understanding the application puts candidates in the best position to maximise points and secure a training post in their preferred location. Ophthalmology applicants are fortunate to have a wealth of information at their disposal. With detailed information available from the Severn deanery, and rich online resources such as Eyedocs, and the Journal of Foundations of Ophthalmology, there is plenty of guidance available for those looking to apply.
2) Prepare Your Portfolio Early
Now comprising half of the total application, an excellent portfolio is a commonality amongst successful candidates. This, however, may be a lengthy process and some points, such a generating research output and completing full cycle audits, may require over a year of work. It is therefore key to start working on the portfolio early, speaking with the local ophthalmology department is a good place to start and will allow applicants to identify opportunities that may be locally available to them.
3) Take Advantage of New Opportunities
The acceptance of the digital platform into the mainstream has facilitated the delivery and attendance of educational courses and academic meetings, and the co-ordinated efforts of the scientific community against Covid-19 have resulted in an exponential increase in academic output. Savvy applicants have taken advantage of novel opportunities that have presented themselves during this time and future applicants should look to do the same.
4) Start Revising for the MSRA Early
The trend of rising MSRA cut-off scores means that this exam will be a major bottleneck. Revising early ensures candidates have the best chance of securing an interview. Online question banks such as Passmedicine and MCQBank are some of the most used resources for this exam.
5) Prepare Your Online Environment
Along with interviews, many conferences and exams like the FRCOphth part 1 are now held online. Investing in a good webcam, microphone and ensuring a stable internet connection should be among the list of priorities for those looking to apply to OST in the current environment.
Best of luck to all those applying in 2023 and beyond!
References
1. Specialty Training Competition Ratios [Internet]. specialtytraining.hee.nhs.uk. Health Education England; Available from: https://specialtytraining.hee.nhs.uk/Competition-Ratios
2. Current Vacancies – Severn PGME [Internet]. severndeanery.nhs.uk. Available from: https://severndeanery.nhs.uk/recruitment/vacancies/show/oph-st1-2022
3. Multi-Specialty Recruitment Assessment (MSRA) [Internet]. severndeanery.nhs.uk. Available from: https://severndeanery.nhs.uk/recruitment/vacancies/show/oph-st1-2022/msra-lib
4. Bandyopadhyay S, Georgiou I, Bligh E, Coyle C, Pancharatnam R, Saunders KEA, et al. SPICE-19: a 3-Month Prospective Cohort Study of 640 Medical Students and Foundation Doctors. Medical Science Educator. 2021;31(5).
5. Ooi SZY, Ooi R. Impact of the recent changes of the Multi-Specialty Recruitment Assessment (MSRA) weightage in specialty training recruitment during the COVID-19 pandemic. Postgraduate Medical Journal. 2021; postgradmedj-2021-139808.
6. Eye to Eye: An Ophthalmology Podcast from the Royal College of Ophthalmologists – Eye to Eye Ophthalmology: Specialty Recruitment Your Questions Answered [Internet]. Google Podcasts. 2021. Available from: https://www.rcophth.ac.uk/news-views/eye-to-eye-ophthalmology-specialty-recruitment-your-questions-answered/
7. Zielinska AP, Mawhinney JA, Grundmann N, Bratsos S, Ho JSY, Khajuria A. Virtual Interview, Real Anxiety: Prospective Evaluation of a Focused Teaching Programme on Confidence Levels Among Medical Students Applying for Academic Clinical Posts. Advances in Medical Education and Practice. 2021; 12:675–83.
8. Crabtree L. A Guide to the Online ST1 Ophthalmology Interview. Journal of the Foundations of Ophthalmology [Internet]. 2021; Available from: https://jfophth.com/guide-to-online-st1-ophthalmology-interview/