Ameeta Kumar

Introduction

The FRCOphth Part 1 exam is the first of three fellowships exams completed during ophthalmology training. Despite this, it has one of the lowest pass rates at around 40% (April 2021). The exam consists of two papers, each containing 90 multiple-choice questions. Each paper lasts 2 hours with a 1-hour break in between. Due to the COVID pandemic, it is currently conducted as an online proctored examination. There are various opportunities to sit the exam throughout the year (January, April and October), with a maximum of 6 attempts allowed per candidate.

As part of the ophthalmic specialist training (OST), all trainees will need to have completed the exam by the end of their second year (OST2). As the exam counts for 3 points in the portfolio component for OST applications, many applicants attempt the exam before entering training. However, this is no easy feat, especially if you did not have an ophthalmology rotation as a Foundation trainee.

Here, we will go through the structure of the exam and some essential resources that helped me pass the FRCOphth exam on my first attempt!

Content of the exams

The exam is focused mainly on basic sciences, with questions covering:

• Anatomy
• Physiology
• Biochemistry and cell biology
• Pathology, including microbiology, immunology
• Growth and senescence, including embryology and the ageing process
• Optics
• Pharmacology
• Lasers and instruments
• Epidemiology and statistics
• Genetics
• Investigations

Questions can vary in difficulty from basic cell biology covered at medical school to two-level questions, which require interpretation of a scan to determine the management.

Resources

Despite the number of trainees, both in the UK and abroad, writing these exams, good quality resources for the FRCOphth are limited. Detailed below are some of the popular textbooks recommended for the exam, as well as newer resources I had used to supplement my revision.

Textbooks

Clinical Anatomy of the Eye (Snell and Lemp, 1998): Excellent resource for anatomy and embryology with diagrams and quoted by many trainees as essential for Part 1. Despite being anatomy focussed, the text does include explanations of how various pathologies may arise, which I found helpful in correlating basic principles with clinical conditions.

Clinical Optics (Elkington, Frank and Greaney, 1999): The go-to resource for optics! People often comment that each sentence can be a possible exam question. One thing to note is that the book was published two decades ago, and it would be prudent to revise newer investigations and lasers using other resources.

Basic Sciences in Ophthalmology (Ferris, 1998): This book was written as a self-assessment text and feature a series of true and false questions preceding small sections of explanations. In comparison to the other books, this offers a more interactive method of studying key points and can be an efficient way to consolidate knowledge.

Basic Sciences for Ophthalmology (Bye, Modi and Stanford, 2013): This book encompasses the various sections of the exam and provides an easy-to-read overview, which can be supplemented with other resources if required. I have noted that the book overlaps in certain parts with the Ferris book, which is quite handy if you cannot get a copy of the elusive Ferris book!

The Eye: Basic Sciences and Practice (Forrester, Dick, McMenamin, Roberts and Pearlman, 5e 2020): This is another recommended textbook that covers multiple sections. It contains a greater level of detail by including the latest research developments. This book took the most amount of time to read, and its thoroughness ultimately made it difficult to distinguish which information was essential for the exam. However, the book utilises brilliant diagrams, with helpful online videos accompanying the newer editions.

FRCOphth Part 1: 400 SBAs and CRQs (Hall and Peden, 2016): The book is structured as three mock papers, which uses the old format for the exam (single best answer questions and constructed response questions). Regardless, an excellent resource encompassing various topic areas and a great way to practice the investigation questions, which can be harder to come across.

Question Banks

Question banks are becoming an increasingly popular way to revise, and there are currently two established banks for the Part 1 exam:

EyeQ (www.eyedocs.co.uk): £79 for three months and £99 for six months. The question bank contains over 2000 questions, with a short explanation accompanying each answer. EyeQ is the older question bank and has been established for several years.

eFRCOphth (www.efrcophth.com): free. This question bank is designed similarly to the PassMedicine bank that many students might have used for medical school exams. There are approximately 1500 questions, with several anatomy questions that include diagrams similar to the real exam.

Both banks offer the possibility of answering questions as a timed test and provide statistics to compare your performance with other candidates.

Websites

MRCOphth (www.mrcophth.com): If you hear mention of ‘Chua’, this is what people are referring to! Formerly catered for the MRCOphth exam, this website still contains valuable nuggets of information, particularly for pathology and investigations. There are also examples of questions from previous exams, although generally, these were easier than the exam.

EyeDocs (www.eyedocs.co.uk): In addition to the question bank EyeQ, EyeDocs offer both a forum, where many previous candidates discuss their experiences of the exam, and a selection of articles on investigations and conditions.

EyeWiki (www.eyewiki.org): As the name suggests, it is an encyclopaedia on ophthalmology written by ophthalmologists. The website is a repository of articles for those who want to read about a topic in further detail. Each condition contains a brief description regarding its epidemiology, features, investigations and management.

Youtube (www.youtube.com): Rather unsurprisingly, YouTube offers a great many videos, which can break up the monotony of reading from textbooks and question banks. These are great for visualising complex processes and techniques, such as the development of the eye, which can be hard to appreciate with just text alone. Channels I used include NinjaNerd (embryology), Tim Root (optics) and ilovepathology (mainly for skin cancers).

FRCOphth Notes (www.FRCOphthNotes.com) This is a relatively new revision platform which offers a selection of high yield articles with accompanying quizzes – useful for building a foundation of knowledge before tackling proper MCQ banks.

General Advice

The exam requires early preparation and can take up to 3-4 months, with more intense revision in the week or two preceding the exam. In the week leading up to the exam, make sure to look through the EyeDocs forum to look at previous questions, practice optic ray diagrams and revise basic statistics, which is sure to come up and are easy points to grab!

Everyone has different learning styles, and a combination of the above resources can be used to suit you. As the exam is conducted online, ensure that you are working in a quiet, clean environment with a good internet connection.

Overall, preparing for the exam will undoubtedly help as an ophthalmology trainee and should be considered a valuable learning opportunity regardless of the outcome!