Wei Han Ong¹

¹ Foundation Doctor, Ninewells Hospital, NHS Tayside, Dundee, United Kingdom

If you’re a final year medical student thinking about how to rank your foundation jobs, first of all congratulations for making this far! We all know ranking foundation jobs can be tough and stressful. The choices you make will potentially have a great impact on what area you specialise in. Thinking about a career in ophthalmology? This article serves to give you some insight into a foundation job in ophthalmology and hopefully guide you along your decision.

Why should you do an FY post in Ophthalmology?

Ophthalmology is a hugely popular career and a competitive specialty to get into. It is undeniably a fulfilling profession having the skills and knowledge to improve a  patient’s quality of life by restoring their eyesight . According to UK medical training recruitment, there was a gradual rise in competition ratios in recent years: 3.24 (2019), 5.73 (2020), and 6.80 (2021); 8.97 (2022) (1). This is not a reason to be put off, but does mean that careful planning and organisation are required to give yourself the best chance of gaining a place. While having a rotation in Ophthalmology doesn’t give you any point, there are certainly a lot more you can get out of an ophthalmology rotation (12 points allocated for commitment to speciality) (2). Not only does working as a foundation doctor in the department gives you an insight into training and determining whether you would enjoy the job but also gives you a crucial head start in building competencies such as taking ophthalmic history taking, using a slit lamp or tonometry.

Now let’s dive into how to make the most out of your foundation rotation:

1.       Clinic and theatre experiences

As we all know, ophthalmology is largely an outpatient specialty. The ward is usually filled with patients for day case surgery, with no ward round. Whenever possible, I would strongly recommend joining the theatre or clinic lists. The clinics can often be very specialised, for example corneal clinic or macula clinic which can be helpful in widening your exposure and understanding regarding these specific ophthalmic disorders. Nevertheless, the ‘ARC’ acute referral clinic (or Eye Casualty) is probably the most useful one in terms of learning opportunities as most emergency cases get referred to this clinic. Importantly, when you’re attending this clinic, keep a logbook of it! The same applies to attending theatre lists. Most medical schools only offer 1-2 weeks of ophthalmology rotation during undergraduate training, so this is probably the best time to expose yourself more to the world of ophthalmology if you are keen.

2.       Eyesi surgical simulator

Most deaneries have at least one simulator in the ophthalmology department, please make use of it when you are on the rotation. Eyesi Surgical is a high-end virtual reality simulator for intraocular surgery training. The training units range from basic skills training through to surgical procedures and complications management (3). For instance, the cataract courses include training modules for capsulorhexis, hydrodissection, phaco, irrigation/aspiration and IOL insertion. This highly realistic simulation gives you a feel of performing microsurgical skills surgery- without risk for real patients. Again, a record of at least 4 hours of training with Eyesi simulator gives you another point for commitment to speciality.

3.       Research/ Audit opportunity

Another plus point of doing an ophthalmology rotation is the opportunity to make connections with the registrar or consultant to be involved in any projects that they are undertaking. It is always advisable to start early as most projects take time to establish. If you manage to join a good team, you might even have the chance to get your name onto a published article. Audit can be done in a simpler and more straight forward approach (and its equally important if not more). According to the new Severn deanery ophthalmology evidence folder published in 2022, an audit can get you up to 4 points in most cases (5 point if its published) so it is really important to get involved in audit/ quality improvement projects during your foundation year. There are also 2 additional points allocated for writing up any case report/ article in ophthalmology to show your interest in the specialty (but be mindful that topic has to be on ophthalmology according to the updated portfolio guidelines).

4.       Presentations & Prizes

Moving forward, once you get involved in any research projects/ audits, always aim to submit your work for a poster/ oral presentation. The size of the conference can range from local meeting to international conference, and all of them get you points! The truth is most conferences have relatively low threshold for poster presentation acceptance so you will definitely get accepted somewhere if you try. Who knows, you might win a prize for best poster/ best paper at one of these conferences which again, gets you additional points!

5.       Departmental teachings

There is usually departmental education for trainees which often runs for a half day each week. It is often run by the consultants, delivering teaching at a post graduate level. This is also the chance for trainees/foundation doctors to do case presentation. If you are working in a teaching hospital, try to organise medical student teaching with the department as it can help to contribute to your portfolio as well (1 point).

6.       Time to prepare for professional exams

To apply for the Ophthalmology specialty training (OST), all candidates are required to sit for the MSRA exam. Ophthalmology rotation might just serve as one of the rotations which gives you more flexible timetable to manage your own studying (as compared to busier rotations like general surgery for instance!). Some might go an extra step to sit for the FRCOphth part 1 exam during foundation training, which is an excellent for the portfolio if you pass (3 points). Nevertheless, it is notoriously known as a tough exam so doing an ophthalmology rotation might just enhance your chance of passing the exam where you consolidate textbook knowledge into clinical practice.

On the other side of the spectrum, even if you’re not interested in a career pathway in Ophthalmology, the skills you gained in eye casualty can be immensely helpful when you go on to do other rotation or even future career. This is suggested by the evidence that a growing number of junior doctors are making poor ophthalmology referral (4). This is unsurprising due to the low exposure of ophthalmology training. Therefore, being confidence in managing acute eye problem can be an incredibly useful and rewarding skill to have.

Finally, some personal reflection on my experience working as a foundation doctor in ophthalmology. My daily job usually starts by admitting patients for day case surgery, follow them through theatre and manage any post-operative complications if necessary. While foundation doctors are not qualified to run clinics, I often sit in with the trainees or consultant in the eye clinic and help to perform some basic examinations. During my 4 months in the department, I have managed to observe some really interesting surgery including enucleation of the eye and encountered many patients with severe sight threatening conditions eg. bilateral compressive optic neuropathy that require emergency treatment. Overall, it’s been an eye opening experience for me to work as a junior doctor in the eye department and this rotation affirmed my growing passion to build a career in ophthalmology. While it can be a sharp learning curve initially having no any prior experience in ophthalmology, the team were generally very supportive, friendly and encouraging.

Key take home messages:

• An ophthalmology foundation post might give you a head start in building your portfolio and boost your chance of entering ophthalmology training
• Apply for the job! But if you don’t get it, it’s not the end of the world and there are still plenty chances to get involve with the department if you’re keen! (e.g. Taster week)