Mark McKeague

The Ophthalmology Specialty Training pathway continues to be one of the most competitive in the UK, with approximately 9 applicants for each available position [1]. The application process undergoes annual modifications, and the 2023/2024 cycle has introduced some significant changes compared to previous years.

Similar to previous application cycles, the process remains structured in three stages:

1. MSRA Assessment: Due to take place between the 4^th and 16^th of January 2024.
2. Evidence Folder (Portfolio) Assessment: Candidates submit a portfolio of  their qualifications and achievements. This is to be submitted by the 13^th of February.
3. Online Interview: Due to take place on the 15^th of March.

The way in which applications are processed has changed significantly in the 2023/2024 cycle. Previously a cut-off score on the MSRA was set and all applicants meeting that cut-off were invited to submit their portfolios and attend an online interview. This is no longer the case; only the the top scoring 300 applicants in the MSRA will progress to have their portfolios reviewed and only those applicants scoring >40% in the portfolio will be invited to take part in the interview.

The interview format has also changed this year. In the previous cycle the interview consisted of one 10-minute-long communication skills task, while this year the interview will involve an additional 10-minute-long history taking task, focussing on clinical judgement.

Perhaps the most significant alteration this year is the weighting that each individual component contributes to the candidate’s overall score. In previous cycles, a candidate’s MSRA score comprised 20% of their overall score, the interview 30% and portfolio 50%. It appears that in the 2023/24 cycle, the portfolio will still count for 50% but the interview weighting has been expanded and will now constitute the remaining 50% of the candidate’s total score. The MSRA score is no longer factored into the final application score once the cut-off for portfolio review has been met.

The changes to the grading of the portfolio section have been highlighted below, however the most significant are the following:

1) There is one extra point available in “Degrees” and one extra point available in “Prizes”. One less point is available in the “MSF” section, with this section having a new maximum of three points available. The maximum possible number of points in the portfolio has therefore increased from 50 to 51.

2) It has now been made explicit that the same piece of research cannot be used to fulfil both the “Presentation” and “Publication” sections.

3) Several changes have been made to the weighting of pieces of evidence as indicated in the table.

Domain Headings	Guidance
List of Previous posts	Please include a list of all your previous posts (your most recent post first).  If you are not currently working within a clinical post please specify. This is to give context to your achievements and is not scored.
Qualifications with certificates or letter of proof	CUMULATIVE SCORING (Maximum 5 points) [2023 change; increase of 1 point compared to 2022] Please note that a cross-specialty requirement that intercalated one-year degrees taken during a primary medical degree are not scored has been imposed. Please state explicitly if any additional degrees to your primary degree are intercalated or not intercalated. Any degree designations not mentioned below must have 1 point – per qualification taken as a separate course separate from the primary degree for at least 8 months full-time or equivalent- MSc, BSc, PG Cert (including Optometry degrees but NOT intercalated degrees).   3 points [2023 change; Increase of 1 point compared to 2022]– for an MD or MPhil degree taken as a separate course before or after the primary degree. If you gained your medical qualification in a country where all students are automatically awarded an MD without additional study you cannot claim points for that MD. You may only claim points for an MD/ MPhil where you have undertaken a period of 2 years full time additional study and research and you must present a Supervisor’s letter confirming this. 4 points  – for a completed PhD or DPhil. You must have undertaken full-time research involving original work, usually of at least three years’ duration, and ideally resulting in one or more peer-reviewed publication. You must present a Supervisor’s letter confirming this. [2023 change; Increase of 1 point compared to 2022 specification] MRCP, MRCS, Diploma in Child Health are not scored.
Prizes/Awards with proof	CUMULATIVE SCORING (Maximum 6 points) [2023 change; Increase of 1 point compared to 2022 specification] 3 points – for Crombie Medal (1st place in FRCOphth part 1 exam) [2023 change; increase of 1 point] 2 points – 1st in final undergraduate degree or equivalent e.g. Honours or Distinction where < 15% of the year achieve this. Evidence explicitly demonstrating this must be presented. Achievement in intercalated degrees is not scored. Degrees preceding or following a primary medical degree can be scored on this basis where < 15% of the year achieve this. National Undergraduate prize through competitive examination (in any specialty), e.g. The Duke-Elder prize: 2 points for coming in top 10% of entrants, 0.5 points for being in the top 60% (40th centile or a pass in 2016 or earlier Duke-Elder sittings). For any other prize please indicate the number of entrants and your position. 1 point will be awarded for being in the top 20% of entrants. 0.5 points each- for Best presentation or poster at a national or international meeting (may also be used in evidence for Presentations section). [2023 change; reduction of 0.5 points for top 60%] 0.5 points each- for a successful research grant application where the candidate was lead author and the application led to peer-reviewed published research. Travel and other bursaries will not be scored unless there are exceptional circumstances/ achievement demonstrated. [2023 change; reduction of 0.5 points] 0.5 points each (maximum 2 points within this section) for each prize / distinction/ merit related to parts of the medical or dental course or Foundation Programme awarded to no more than the top 20% of students and doctors. Evidence explicitly demonstrating this must be presented. [2023 change; Added clarity regarding weighting, likely represents reduction of 0.5 points per achievement]
Ophthalmology specialty links and commitment to date as a career	CUMULATIVE SCORING (Maximum 12 points) Refraction Certificate (or optometry exemption):   2 points   FRCOphth part 1:  3 points Non-peer reviewed publications (0.5 point each) & case reports in ophthalmology or other peer-reviewed research publications in ophthalmology not included in other sections (1 point each): 2 points max. within this section (points only awarded if candidate is first author). Please indicate clearly impact of non peer-reviewed publications. [2023 change; Reduction of 0.5 points for non-peer reviewed publications] Ophthalmic elective and/or separate undergraduate project:  2 points max., 1 point per achievement. Please provide evidence of reflection on achievements. If electives were cancelled due to COVID and evidence is provided that an elective was planned then this can be scored. Taster week: 1 point max. Attending ophthalmology clinics and theatre sessions outside of a formal taster week and spaced out over more than 3 months (minimum 10 sessions with dates & supervisor-signed evidence): 1 point max. [2023 change; 3 month specification newly added]   EyeSi assessments (minimum 4 hours: 1 point max.) Evidence of other ophthalmology simulation training (1 point max.) Meetings attended: 3 points maximum, from which 3 points max for National / International Ophthalmology educational meetings attended (1 point per meeting)  and 1 point max for Regional Ophthalmology meetings (including Royal Society of Medicine Ophthalmology Section) attended (0.5 points per meeting). Evidence not included above- discretionary: 2 point max. (not including taking Duke-Elder, logbook of surgical cases or WBAs). [2023 change; 1 additional point available as discretionary]
Multi-Source Feedback (MSF)	(Maximum 3 points) [2023 change; reduction of 1 point] The MSF must have been taken place within 18 months of the interview date if the candidate has been in clinical posts for this period. Candidates not currently within a clinical post who do not have an MSF within the timeframe (e.g. undertaking a longer period of research or an extended period of leave) should include the MSF from their most recent clinical post. The MSF should include feedback from a minimum of 5 respondents if in a general practice post or 7 respondents if in a hospital post.  Your educational supervisor or equivalent supervisor should collate this information and summarise it in a report. The report should include the period the MSF covered.   The report must be signed by the educational supervisor or department lead and stamped with a departmental stamp unless including a standard Team Assessment Behaviour Form (TAB) printed from E-portfolio which does not require a signature or departmental stamp. For candidates without access to an on-line portfolio or unfamiliar with the MSF process information can be accessed from the link below. Points will be awarded as follows: 0 points – for significant negative comments 1 point – minor negative comments or non-satisfactory scores 2 points – satisfactory scores with appropriate good comments 3 points – satisfactory scores with multiple superlative positive comments, e.g. “best trainee I have ever worked with”.
Publications	(Maximum score 6 points) Candidates cannot place the same work in both presentations and publications domains. Please choose which domain to include the work in. [2023 change; previously unspecified] List peer-reviewed original research publications or systematic review articles (not letters to a journal) with the pro forma information detailed below and then after each pro forma information in turn, upload a photocopy of the first page of each paper. No marks will be given without a copy of the first page of either a published or “in press” paper and in the latter case evidence of final acceptance for publication must be presented. On the pro forma list each piece of evidence including the citation of the journal (author’s name(s), article title, journal name/title, volume of journal, issue number of journal, page or range of pages, year of publication and DOI or URL) and indicate whether you were 1st, 2nd, 3rd or 4th author. 3 points for each publication where you are 1st author or joint first author and 1 point for any other publications up to 4th author (unless > 8 authors in total for article when 1st author only counted). If you are one of three or more joint first authors then you will be scored as a second author. If there are more than 6 joint first authors then no score will be given. No points will be awarded in this section if you are 5th author or lower in the citation. No points will be awarded in this section for case reports. This evidence can be included in “Ophthalmology specialty links and commitment to date as a career” if the work is in Ophthalmology. Quality of the work presented and impact of the journal may be taken into account when scoring.
Quality improvement / Audit projects	(Maximum score 5 points) Copy of your best QI project or audit, performed within the last 3 years of the interview date, with a short summary of your specific role in the project / audit.  The audit should have standards, outcomes and recommendations.  There needs to be a covering letter explicitly confirming your role in the project signed by the supervising consultant. This is especially important to confirm the points to be awarded as below. A covering letter or certificate are necessary for proof of presentation at any meeting. Points will be awarded as follows: 0 points – if no evidence of QI / audit work in portfolio.                               1 point – for participation but no specific roles documented or specific format followed. 2 points – for initiation and design of the QIP / audit and some evidence of specific format. 3 points – for initiation, design and writing up the QIP / audit and specific format followed. 4 points – as above and was personally involved in implementing the QI strategy / completing the audit loop and implementing change  5 points – for published audit (not to be added to Publications section) or QI guidelines implemented supra-regionally. Note: Some modification of these marks may be made dependent on quality of project and impact of the work. If you are not clearly lead on the project then the maximum score is 1 point.
Presentations	CUMULATIVE SCORING (Maximum score 6 Points) List of presentations and copies of abstracts or posters, stating whether it is a poster presentation or oral presentation.  Proof must be uploaded through an abstract book or signed letter from supervisor. Presentations must be of original work and not didactic lectures. 1 Point – Regional presentations (For example regional ophthalmology society meetings or other specialty equivalents in the UK or regional ophthalmology meetings of other countries or equivalent non-ophthalmology meetings. Regional designation includes specifically English, Scottish, Welsh meetings). Local hospital or university-specific meetings are not scored. 2 Points – National presentations (For example, RCOphth Congress, British Oculoplastic Surgery Society, or other specialty equivalents in the UK or national ophthalmology meetings of other countries or equivalent non-ophthalmology meetings)  3 Points – International meetings – (For example Association for Research in Vision and Ophthalmology, American Academy of Ophthalmology, etc or equivalent international non-ophthalmology meetings.) Meetings in non-UK countries where explicit evidence is not presented as to the international nature of the meeting are scored as national or regional meetings. NB: The same paper presented at different meetings will only be counted once e.g. the highest-ranking meeting. Also: Accepted presentations, but not yet presented, will be awarded points.Oral presentations score points as shown above, e.g. 2 points at national meeting.Poster presentations score half points shown above, e.g. 1 point at national meeting.Second author or lower scores a half of the oral presentation or poster points, e.g. 0.5 points for a poster at national meeting.  Candidates cannot place the same work in both the presentations and publications domains. Please choose which domain to include the work in.
Education and Teaching	CUMULATIVE SCORING (Maximum Score 5 Points) Scores will be awarded as follows; 0.5 points each – for helping with an educational course (more than one session), designing an e-learning tool, writing an e-book, completing a “teaching the teachers” course and/or undertaking a formal role in examining undergraduates. [2023 change; reduction of 0.5 points per achievement] 1 point – for contributing to at least three teaching sessions over a period of at least 3 months with formal feedback uploaded. 2 points – for a Higher teaching qualification e.g. a Diploma, Certificate in Medical education. 2 points – for writing a chapter in a postgraduate-level academic book (not an e-book or self-published book). Specific evidence of the publisher and impact of the book must be shown. 3 points – for writing a postgraduate-level academic book (not an e-book or self-published book). Specific evidence of the publisher and impact of the book must be shown. All evidence must come with either photocopies of a chapter index, attendance certificate or a signed letter from a supervisory Consultant/ Educator etc. as supporting evidence. Specific evidence demonstrating impact of e-learning projects or other teaching achievements must be presented. Specific evidence of impact of e-books in numbers downloaded or otherwise accessed must be presented.
Overall portfolio layout & quality	(Maximum Score 3 Points) Layout, organisation and quality of how it is presented will be assessed.

Summary

Whilst the MSRA assessment no longer contributes to a candidate’s overall application score, the fact that only the top 300 scoring applicants will progress past this stage means it will likely exert a greater influence than in previous years.

Several achievements listed in the portfolio section are now worth half of the points compared to previously.

The overall structure of the portfolio and the application process in general remains very similar to previous years, however important changes have occurred which may make it more difficult for some candidates to score well in the portfolio.

References

1. https://medical.hee.nhs.uk/medical-training-recruitment/medical-specialty-training/competition-ratios/2022-competition-ratios (accessed 30/10/23)

2. https://www.severndeanery.nhs.uk/recruitment/vacancies/show/oph-st1-24/applicant-guide-lib (accessed 30/10/23)