Never too late: Starting your OST portfolio as a Foundation Doctor

  • Post author:Hui Mei Wong, Kristie Hing Chi Leung
  • DOIDOI:10.48089/jfo7689070

Hui Mei Wong1, Kristie Hing Chi Leung2

1The Whittington Hospital, UK

2University College London, UK


Ophthalmology is one of the most competitive specialities to get into, with a competition ratio of 6.80 and 89 positions nationwide in 2021 (1). Most successful applicants have developed a competitive portfolio from medical school, maximizing undergraduate specific opportunities such as organizing an Ophthalmology elective project or student selected module. Many may also have applied for undergraduate prizes such as the Duke Elder Undergraduate examination and the Patrick Trevor Roper Prize. Others may also have obtained additional Bachelor’s degrees, Masters or pursuing a PhD to further improve their portfolio.

Advice on preparing the Ophthalmology Speciality Training (OST) portfolio often assumes that the applicant is still in medical school or at a relatively early stage of their career, which can be disheartening for applicants who decide to pursue Ophthalmology later on in their careers (such as during Foundation Years 2 or 3), as this cohort of applicants would have to develop their portfolio within a much shorter timeframe. This article aims to highlight high-yield elements within the OST to maximize points, focusing on applicants who decided to pursue Ophthalmology in their Foundation Years.

The key to a successful application is to tailor your portfolio to the evidence folder requirements, which is published on the Severn Deanery website approximately four months prior to the start of the interview period. Here we list some of the key tips on how to Please note that the tips below are based on the 2021 Evidence Folder, which will be subject to change when the 2022 version is published. We have also linked real examples of what we have done to help you generate ideas on how to maximise your portfolio marks.

Taster Week

Arrange a taster week early! Organizing a taster week will award you one point as proof of demonstrating your interest in the speciality. Prepare a letter with formal letterhead signed by your consultant and include this as evidence within your portfolio.

You can kill two birds with one stone by organizing a minimum of ten sessions during your taster week, with a mix of clinics and theatres, as this scores you another point. Prepare a ‘logbook’ style letter where you can collect signed evidence of your attendance to include within your portfolio.

In general, there are several benefits to organizing a taster week as early as you can. Through developing links with the local team, you may have further opportunity to return to eye clinics or theatres regularly, which can score you yet another point on the OST. You can also highlight your interest in getting involved in any audits or projects and will allow time for you to develop this, particularly if you are joining your local ophthalmology department.

“I started emailing different Ophthalmology consultants and fellows in December 2021 to try to organise an Ophthalmology taster week. I was keen to be attached to my local Ophthalmology department to facilitate future visits and research opportunities. The process to identify a suitable person to contact and organise this taster week was the most time-consuming aspect.

The following practical steps helped me to eventually organise my taster week.

1) Visiting the Eye Clinic in person to speak to a doctor to enquire about organising a taster week.

2) I also highlighted my interest in organising this taster week to my own team – my ward registrar went above and beyond and spoke to the ophthalmology registrar who was very happy to point me in the right direction to organise this.

3) After establishing contact with the department, I highlighted my interest in completing 10 sessions throughout my placement and a timetable was drafted.

4) I prepared a letter with the formal hospital letterhead and obtained a signature from the Head of Department confirming that I had attended 10 sessions during my taster week. I also prepared a separate ‘logbook’ style letter with the individual clinics and consultants listed and I obtained their signatures after attending their clinics, providing further evidence.”


Publishing original, peer-reviewed research articles is the gold standard, but full research projects can take time and may not be the most time efficient with a pending deadline for OST applications. Consider non-peer reviewed articles to demonstrate your interest as you can score a maximum of four points. This includes letters to the editors and publications in EyeNews; but please note that you will need to be the first author to score a point.

If there is sufficient time before your application, you can consider writing up a systematic review in an area of your interest. This minimizes the risk of your publication being waylaid by factors beyond your control which may happen with original research projects.

“We have written short pieces in EyeNews and the Journal of the Foundations of Ophthalmology on our elective experience and how to organise an elective overseas. This article you are currently reading is another example of how you can demonstrate your interest in the specialty! These will count as non-peer reviewed articles within your portfolio. Articles published within EyeNews will also require a consultant’s review if you are a foundation doctor.

Some other non-peer reviewed publication ideas include
1) Letters to editors
2) A short review on the latest studies or ‘hot topics’ within Ophthalmology”

Quality Improvement Project

All Foundation Doctors are expected to demonstrate evidence of involvement in a quality improvement project to pass the ARCP. I personally find that this is one of the most versatile elements and is worth investing time and effort into developing this well.

Start one early! The OST portfolio only requires your best audit or quality improvement (QI) project – hence it is better to focus on one project than to split your attention across multiple different projects. It is advantageous to demonstrate multiple PDSA cycles within a QI project. This may initially appear daunting, but a QI approach encourages small changes with clear measurements pre and post intervention, then reflecting on this to make further interventions to achieve the objective.

Your QI project can be presented at international or national conferences, which will score you marks on the presentation section. If your poster is selected for a poster or oral presentation, you may also gain further points if you win the Best Poster or Best Presentation Award. A good project can also be written up for peer-reviewed publication, which can gain further points under the publications section. 

“I started a QI project in improving VTE risk assessments in September 2021 during my first FY1 rotation. The data collection continued until December 2021 and I submitted this for a poster presentation in the National Bristol Patient Safety Conference 2022. This was selected for an oral presentation. I also presented my work at our local QI celebration day and we are aiming to write up the results for publication.”

Other aspects to consider…

Find a Buddy!

Identifying other friends who are interested in pursuing Ophthalmology and working together can help you get through the more difficult parts of the application process. Working as a team allows you to identify more opportunities together and share your resources. Applying for ophthalmology can be a lonely process as it is a speciality separate from the usual medical and surgical training pathways and having a buddy to keep you accountable and encourage you through the challenges can go a long way!


The FRCOphth Part 1 examination is an optional examination which you may choose to sit for prior to your OST application. Sitting for this examination prior to getting into OST is controversial. Passing this examination will score you three points on the OST portfolio, which can be advantageous in the application process. However, it is important to take a step back and realistically gauge your capacity to invest time and effort into this examination. The FRCOphth Part 1 examination is a challenge to pass with limited to no clinical exposure prior to starting the OST and will require significant hard work and preparation. Consider if it may be more worthwhile investing the same amount of time into other projects or courses which may gain you more marks cumulatively.

In Summary…

Do not lose heart! It is never too late to start developing your OST portfolio, and there are many opportunities available as a Foundation Doctor to help you score points on the OST. Planning ahead and arranging taster weeks or projects to gain multiple points in different sections of the evidence folder can help you to ace your OST portfolio.


  1. Health Education England, 2022. 2021 Competition Ratios Nationally Advertised Vacancies. Available at: [Accessed 7 August 2022].

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