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					The Royal College of Ophthalmologists
17 Cornwall Terrace, London. NW1 4QW.
Telephone: 020-7935 0702, Extension 213
Facsimile: 020-7487 4674
Email: exams@rcophth.ac.uk
Website: WWW.RCOPHTH.AC.UK

FROM THE EXAMINATIONS DEPARTMENT                                         PATRON HRH THE DUKE OF YORK, KCVO, ADC




Dear Colleague

Thank you for your enquiry concerning the College’s Part 2 Fellowship (FRCOphth)
Examination.

I enclose copies of the current:          Registration Information
                                          Admission Procedure
                                          Guidance for Candidates with Additional Needs
                                          Policy on Allegations of Cheating in Examinations
                                          Language Requirements
                                          Fees Schedule
                                          Examination Timetable
                                          Examination Structure
                                          Standard Setting
                                          Examination Syllabus
                                          Application Form
                                          Equal Opportunities Form

Candidates must hold a medical qualification approved by the General Medical Council of the
United Kingdom (GMC) or of Ireland for the purpose of registration.

The examination structure is based on the learning outcomes from the Curriculum for
Ophthalmic Specialist Training in its entirety. This curriculum is only available in web-based
format at http://curriculum.rcophth.ac.uk/.

The examination is run twice yearly in February/April and September/November. Candidates in
OST will be required to pass this examination by the end of year seven of ophthalmic
specialist training.

The above information has been agreed by the Council of The Royal College of
Ophthalmologists.

This information is subject to variation at the discretion of the Council.

Yours sincerely

Emily Beet
Head of the Examinations Department




                                                     1
Regulations

The following notes on the regulations concerning applications for admission to the
examinations are published for the guidance of candidates:

   1. Completed application forms for admission to an examination must reach the
      Examinations Department no later than 5.00pm on the closing date, namely
      approximately FIFTY-SIX days before the exam is held. It is not possible to accept
      applications received after the closing date.

   2. The application forms must be accompanied by the fee and such certification as is
      required by the regulations. If you cannot supply all the relevant information you
      must contact the Examinations Department or supply a covering letter as to the
      reasons why. All information must be sent within 14 days after the closing date, if
      not before, otherwise the candidate will be withdrawn from the examination and forfeit
      their examination fee.

   3. Upon receipt of application the Examinations Department will send all candidates a
      written receipt. Detailed instructions including written and clinical examination dates
      will be dispatched to all candidates within ten days after the closing date for receipt of
      applications.

   4. Applicants wishing to withdraw or transfer their entry for an examination must notify the
      Examinations Department in writing by 5.00pm on the closing date for receipt of
      applications. Fees cannot be refunded or transferred after this time.

   5. Applicants must apply for entry visas for the United Kingdom in good time prior to the
      date of the examination. If a candidate is refused a visa after the closing date of receipt
      of applications they will forfeit their examination fee. If written evidence of the refusal of
      a visa is provided, the Examinations Committee will consider requests for candidates to
      transfer their examination entry subject to the receipt of a 20% administration charge.

   6. Candidates unable to attend an examination will forfeit their examination fee. In
      exceptional circumstances, the Examinations Committee will consider requests to
      transfer a candidate’s entry to the next examination sitting subject to receipt of written
      supplementary evidence (e.g. a medical certificate, a death certificate for a close family
      member) and subject to a 20% administration charge. Please note that lack of
      preparation is not considered a suitable reason to withdraw or transfer an examination
      entry.

   7. All candidates will receive feedback regarding their individual performance in the
      examinations.

   8. Results are posted by First Class Mail with the Pass List being displayed on the
      College Website. Results are only released upon approval of the Senior Examiner.
      We regret that examination results are not available by telephone or email.




                                                 2
Written Examination Procedures

   1. Unless notified, candidates are not permitted to use calculators in any section of the
      examinations.

   2. Candidates are only allowed to bring pens/pencils etc into the examination in a clear
      plastic pencil case or plastic bag.

   3. Candidates are forbidden to communicate in any way with, seek assistance from, give
      assistance to, or interfere with the work of other candidates or the invigilators in the
      examination room or elsewhere during the period of the examination, or indulge in any
      other form of unfair practice.

   4. The Senior Invigilator has the power to expel a candidate from the examination room.

   5. Candidates are advised to read the Policy on Allegations of Cheating in Examinations
      regarding examinations.

   6. Candidates are not allowed to use mobile phones. All mobile phones must be
      switched off and cannot be used as a method of time keeping. Clear instructions
      will be given to candidates regarding the timing of the examination.

   7. Photographic identification (such as a passport or photographic driver’s licence) will be
      checked before candidates are admitted to the examination hall. Candidates are also
      required to sign a register when entering written examinations.

   8. Candidates are NOT permitted to enter a written examination 30 minutes after the
      examination has started. The clock to be referred to will be the clock in the
      examination hall or the Senior Invigilator’s watch.

   9. No candidate is allowed to leave the examination hall in the first 30 minutes of a written
      examination. No candidate is allowed to leave the examination hall in the last 10
      minutes of a written examination to avoid disruption to candidates completing their
      work.

   10. Candidates deciding to leave the examination hall must submit their paper to the
       invigilator. They will not be permitted to re-enter the examination hall.

   11. Candidates are asked to raise their hand should they have a query regarding any part
       of the examination.

   12. Candidates requiring a comfort break must raise their hand and wait to be escorted by
       an invigilator. Only one candidate at a time is permitted outside the examination hall.

   13. No books, written material or electronic equipment are allowed on the candidate’s desk.
       All references to the examination such as letters and individual timetables are not
       permitted on the examination desk.

   14. Candidates are not allowed to use scrap paper, all notes must be written on the
       answer sheet and crossed through as appropriate.

   15. Candidates are advised that no extra time will be given to transfer answers from the
       question paper to the answer sheet.




                                               3
Practical Examination Procedures

   1. Unless notified, candidates are not permitted to use calculators in any section of the
      examinations.

   2. Candidates are only allowed to bring their own clinical equipment into the examination
      in a clear plastic pencil case or plastic bag.

   3. Candidates are forbidden to communicate in any way with, seek assistance from, give
      assistance to, or interfere with the work of other candidates or the invigilators in the
      examination room or elsewhere during the period of the examination, or indulge in any
      other form of unfair practice.

   4. The Senior Invigilator has the power to expel a candidate from the examination.

   5. Candidates are advised to read the Policy on Allegations of Cheating in Examinations
      regarding examinations.

   6. Candidates are not allowed to use mobile phones. All mobile phones must be
      switched off and cannot be used as a method of time keeping. Clear instructions
      will be given to candidates regarding the timing of the examination.

   7. Photographic identification (such as a passport or photographic driver’s licence) will be
      checked before candidates are admitted to the examination.

   8. For clinical examinations, candidates are required to present themselves in good time
      and are required to wear name badges throughout the examination period (these will
      be supplied by the Royal College of Ophthalmologists). The start of the examination
      cannot be delayed for candidates arriving late.

   9. For clinical exams candidates must be appropriately dressed and should follow the
      Department of Health ‘Bare Below the Elbows’ guidelines.

   10. No books, written material or electronic equipment may be consulted during the
       examination and are not permitted on a candidate’s person.

   11. Candidates are not allowed to use scrap paper, all notes must be written on the
       answer sheet and crossed through as appropriate.

   12. Candidates are advised that no extra time will be given to complete their mark sheets
       once the end of the OSCE station has been signalled.




                                                4
Eligibility

A candidate will be eligible to enter the Part 2 FRCOphth examination provided he/she:

a) has passed the Part 1 Fellowship Examination at a date later than 1 October 2006 and has
passed the Refraction Certificate;

or

b) has passed the Part 2 Membership of The Royal College of Ophthalmologists (MRCOphth)
by examination at a date later than 1 January 1997;

or

c) obtained Membership of The Royal College of Ophthalmologists (MRCOphth) by
examination at a date between 1 January 1997 and 30 September 2008;

or

d) has passed the Part 2 Membership of The Royal College of Surgeons of Edinburgh
(MRCSEd) by examination at a date between 1 January 1997 and 31 August 2008*;

or

e) obtained Membership of The Royal College of Surgeons of Edinburgh (MRCSEd) by
examination at a date between 1 January 1997 and 31 August 2008*;


*Candidates entering the examination under eligibility points d) or e) are also required to
submit:

        An attested copy of their medical degree or a copy of their GMC certificate
        An attested copy of their success letter for the Part 2 or Part 3 MRCSEd Examination,
         as appropriate


Condition of the Examination

There is no specific training requirement to enter this examination but it is aimed at trainees in
years 4-7 of ophthalmic specialist training, who are at the end of their general ophthalmic
training (ie not sub-specialty) and who are being considered as suitable to practise
independently. Candidates are unlikely to successfully complete this examination without a
significant period of training in ophthalmology.

Candidates in OST will be required to pass this examination by the end of year seven of
ophthalmic specialist training.




                                                 5
Guidance for Candidates with Additional Requirements

The Royal College of Ophthalmologists recognise that there may be some candidates who
require additional arrangements when undertaking a Royal College of Ophthalmologists
examination.

All candidates who require additional arrangements must adhere to the guidelines set out
below. Candidates must note that upon receipt of sufficient evidence additional arrangements
may not necessarily be granted.

In awarding additional arrangements the Royal College of Ophthalmologists seek to:

          1. Approve valid arrangements and access to written and clinical examinations.
          2. Give special consideration to candidates where specific circumstances have
             arisen at or near to the examination time which have not previously been
             highlighted.
          3. Ensure that no additional arrangement gives an unfair advantage over another
             candidate

When submitting their application form all applicants must make it clear if additional
arrangements are needed in writing and attach this to the application form. Supplementary
evidence will be needed from the candidates such as:

      Doctor’s note
      Up to date literacy assessment
      A Statement of Additional Educational Needs
      A Relevant diagnostic report regarding the learning disability
      Historical evidence of the disability

Extra time award:

An additional allowance of up to and including 25% may be awarded to those candidates
requesting special consideration for extra time and only on approval of the supplementary
evidence.

Specialist equipment:

The Royal College of Ophthalmologist will consider special request from candidates for
specialist equipment such as:

      Additional lighting
      Larger desk to accommodate specialist equipment
      Separate room
      Supervised rest breaks

All additional requirements will be considered by the Chairman of the Examinations
Committee.




                                               6
Policy on Allegations of Cheating in Examinations

You may not take the following into the examination:

      Spare paper including revision notes
      Electrical equipment
      All mobiles phones must be switched off
      Calculators
      Alarms on watches/clocks must be turned off
      Personal belongings should be placed at the back or side of the examination hall, as
       instructed by the invigilator. Valuables should not be brought to the examination as the
       College cannot take responsibility for such items.

NO CANDIDATE IS ALLOWED TO TALK TO, PASS INFORMTION TO, OR SIGNAL TO A
CANDIDATE WHILST THE EXAMINATION IS IN PROGRESS.
It is a serious disciplinary offence to attempt to impersonate another candidate or to have
another person impersonate you during any part of the Royal College of Ophthalmologists
examination/s.

Cheating (whether attempted or successful) will be penalised very severely by the
Examinations Committee of the Royal College of Ophthalmologists. The following are all
considered as attempts on cheating:

      Plagiarism (see www.rcophth.ac.uk/exams/admission for full policy)
      Copying
      Talking
      Passing notes
      Bribery
      Unauthorised access to exam papers
      Taking unauthorised material into the examination
      Copying or alteration of certificates
      Discussing clinical cases with candidates (if they themselves have not yet sat their
       clinical examination)
      N.B. This list is not exhaustive

ALL ID WILL BE CHECKED THOROUGHLY AT THE START OF THE EXAMINATION
In the event of cheating (whether attempted or successful), the following procedures will be
followed:

The script or mark sheets will be marked by the invigilator at the time of the offence and
directly reported to the Head of Examinations.
The invigilator will fill out an invigilation form detailing the time and date of events.
The Chairman of the Examinations Committee will review the situation and decide on the
following course of action:

      The question when the offence took place will be given a mark of 0, or a mark of 0 will
       automatically be awarded for the whole paper.
      Where there is a need to obtain further information the invigilator and candidate in
       question should submit detailed reports of the events, any supplementary evidence
       should also be submitted e.g. revision notes. This report will go to Council. The
       candidate at this point may be disqualified from taking the examination for a number of
       years or be put forward to a disciplinary board that will make a final decision on the
       outcome.
      A candidate may appeal against any decision and the Appeals Procedure will be
       followed under the discretion of the Royal College of Ophthalmologists.
      A Candidate may be reported to the GMC as this is a probity issue.
                                                   7
Language Requirements

All examinations run by the Royal College of Ophthalmologists are conducted in English.

Although candidates are not expected to undertake examinations such as IELTS or PLAB it is
expected that candidates should be equivalent to IELTS Level 7.

Preparing for the examinations

The Royal College of Ophthalmologists recommends that candidates preparing for
examinations should:

             Read the appropriate text, syllabi and curriculum for the relevant examination.
             Gain clinical experience in ophthalmology in hospitals. This may also include
              working within other specialties such and Medicine and Pathology.
             Attend courses – A list of courses for examinations can be found on the College
              website (the College does not run or endorse any of the listed courses).
             Be familiar with Good Medical Practice (from the General Medical Council)

Candidates may also find useful information from the National Advice Centre for Postgraduate
Education. (http://www.nhscareers.nhs.uk/nacpme/)




                                              8
                                          EXAMINATION FEES 2011
PART 1 FELLOWSHIP EXAMINATION

Fee to sit examination                                          £460

PRACTICAL REFRACTION CERTIFICATE                                £550

PART 2 FELLOWSHIP EXAMINATION
                                                                       1
Fee to sit examination                                          £850

Completion fee (to be paid by candidates                        £160
who successfully complete the examination)
1
  Candidates who do not progress from the written component to the practical component will receive a
rebate of 35% of the original fee. This is not available retrospectively for previous candidates.


DIPLOMA IN OPHTHALMOLOGY EXAMINATION

Fee to sit examination                                          £665

Completion fee (to be paid by candidates                        £160
who successfully complete the examination)


FELLOWSHIP ASSESSMENT
                                      2
Fee to sit examination (per attempt )                           £850
           3
Resit Fee                                                       £250

Completion fee (to be paid by candidates                        £160
who successfully complete the assessment)
2
 An attempt constitutes the submission of your casebooks and any subsequent amendments prior to the
proposed interview date. Candidates deemed as unsuccessful after the casebook stage shall not be
permitted to attend for interview. Candidates are required to submit payment of the fee for each attempt.
For example, if a candidate’s casebook do not proceed to interview and a new date is allocated, the full fee
of £850 will be payable. Similarly, if a candidate fails three or more chapters at the interview stage, a new
date must be allocated and payment of the full fee must be submitted.
3
    The resit fee of £250 applies only to candidates re-sitting two chapters or less at the interview stage.


CERTIFICATE IN LASER REFRACTIVE SURGERY

Fee to sit examination (per attempt)                            £1100

An attempt constitutes the submission of Portfolio Assessment and any subsequent amendments prior to the
proposed interview date.

Candidates deemed as unsuccessful after the submission shall not be permitted to attend the Portfolio
Interview or Structured Vivas.

Candidates are required to submit payment of the fee for each attempt.

Additional Payments:
                                                        4
Replica certificates                        £75 + VAT
Appeal procedure                            £200
           5
Duke Elder                                  £15 (Undergraduate Prize Examination)
4
  Until 31 December 2010 VAT is payable at 17.5%; from 1 January 2011 VAT will be payable at the new
rate of 20%
5
  Payments for non-attendance

                                                            9
                     THE ROYAL COLLEGE OF OPHTHALMOLOGISTS

                          PART 2 FRCOPHTH EXAMINATION

                                    TIMETABLE 2011

February & April 2011
Closing Date for Receipt of Applications:        20 December 2010

Written Examination

7 February 2011            London

Practical Examination

4 April – 7 April 2011     The James Cook University Hospital, Middlesbrough

Provisional timetable:
4 April 2011               Structured Viva examination
5 April 2011               Structured Viva examination
6 April 2011               Multi-station clinical examination
7 April 2011               Multi-station clinical examination



September & November 2011
Closing Date for Receipt of Applications:        11 July 2011

Written Examination

5 September 2011           London

Practical Examination

7-10 November 2011         Royal Hallamshire Hospital, Sheffield

Provisional timetable:
7 November 2009            Structured Viva examination
8 November 2009            Structured Viva examination
9 November 2009            Multi-station clinical examination
10 November 2009           Multi-station clinical examination




Candidates successfully completing the Written Component will automatically sit the
Practical Component of the examination approximately 8-10 weeks later. Unsuccessful
candidates will be required to re-sit the Written Component and shall not sit the
Practical Component until the successful completion of the Written Component.
Candidates unsuccessful in the Practical Component will be required to re-sit the
Written Component.




                                            10
The Part 2 FRCOphth Examination

The Part 2 FRCOphth is a synoptic exit examination that uses several different and
complementary assessment methods. Success in this examination allows a doctor to become
a Fellow of the Royal College of Ophthalmologists. It is a necessary but insufficient
requirement for completion of specialty training in the UK.

The examination is blueprinted against the General Medical Council’s Good Medical Practice
and the detailed learning outcomes of the curriculum for Ophthalmic Specialist Training (OST),
which has been approved by the GMC.

Candidates are expected to demonstrate a depth of knowledge and understanding expected of
an independent specialist (consultant) not sub-specialising in the field being tested.
Candidates are required to pass this examination by the end of year seven of ophthalmic
specialist training.

The written component is held twice a year; in February and September. Only candidates who
successfully complete the written component of the examination, i.e. the MCQ and the EMQ,
will automatically proceed to the practical components of the examination approximately 8-10
weeks after the written component.

Candidates are not permitted to defer sitting the practical component for any reason; a pass in
the written components cannot be carried forward to another examination sitting. The two
parts are designed, written and blueprinted as a whole and candidates must ensure they are
available for both dates when applying to sit the examination. Candidates who do not sit the
Practical Component, or are unsuccessful, must resit the written component.

Part 2 FRCOphth - Structure of the Examination

Written Component

A 2 hour MCQ paper of 90 questions consisting of 1 best answer out of 4 options
A 3 hour EMQ paper of 45 questions each consisting of 2 parts, 90 items in total

Practical Component

Structured viva
The Structured Viva will consist of a series of five stations, each of which will be timed for
precise periods of 10 minutes. Station 7 of the OSCE, Communication Skills, will not be
conducted in a clinical setting and will be held at the same time as the Structured Viva, lasting
for a precise period of 10 minutes.

The stations are set out as follows:

Station 1:    Patient investigations and data interpretation
Station 2:    Patient management 1
Station 3:    Patient management 2
Station 4:    Attitudes, ethics and responsibilities
Station 5:    Audit, research and evidence based practice and
              Health promotion and disease prevention

Two examiners will be present at each station for the duration of the cycle.




                                               11
Objective Structured Clinical Examination (OSCE)
The OSCE will consist of a series of six stations, each of which will be timed for precise
periods of 15 minutes. Station 7, Communication Skills, will not be conducted in a clinical
setting and will be held at the same time as the Structured Viva, lasting for a precise period of
10 minutes.

The stations are set out as follows:

Station 1:    Cataract and Anterior Segment
Station 2:    Glaucoma and Lid
Station 3:    Posterior Segment.
Station 4:    Strabismus and Orbit
Station 5:    Medicine
Station 6:    Neurology
Station 7:    Communication Skills (takes place logistically with viva aspect of the exam)

Two examiners will be present at each station for the duration of the cycle. In stations 5 and 6
an ophthalmologist will be paired with a physician/neurologist. In stations 1 – 4, two
ophthalmologists will be paired. In station 7, an ophthalmologist will usually be paired with a
lay examiner. Other than the communications skills station, the examination will take the form
of short cases.

The candidate will be examined on 3 patients per station for stations 1-3 and 2 patients for
station 4, being asked on a specific area on each case. Stations 5 and 6 will be a combined
station and will examine 4 patients in total

Red Flags

Candidates whose performance in any viva or OSCE station has given the examiners cause
for concern eg. indicated unsafe practice, will alert the Senior Examiner by way of a ‘red flag’
on the marksheet. The cause for concern must be documented clearly on the marksheet. If
the candidate’s overall total mark exceeds the agreed pass mark, the Senior Examiner will
review the candidate’s performance with the examiners at this station to decide if the
candidate should fail in spite of the overall mark.

Standard Setting

All examinations are standard set. The written papers are standard set in advance using the
Ebel method. The OSCE and structured vivas are standard set using the borderline candidate
method. All questions are reviewed in the light of performance and modified accordingly.

Overall Result

To pass the Part 2 FRCOphth examination, candidates are required to pass all components
(MCQ, EMQ, Structured Viva and OSCE) although some degree of cross compensation will be
allowed (see below). If awarded a fail, candidates must re-sit the entire examination, even if a
pass was previously achieved in any section.

Cross Compensation

If a candidate marginally fails one written paper, their total marks for both papers will be added
together. If this mark exceeds the combined pass marks for both papers, they will be allowed
to proceed to the second stage of the examination.

If a candidate fails the Structured Viva, their total marks for both the Viva and the OSCE will be
added together. If this mark exceeds the combined pass marks for both papers, they will be
allowed to pass the examination provided there have been NO RED FLAGS identified in either
section. It is NOT possible to compensate a poor OSCE with a good Structured Viva
result.
                                                12
Notification of Results

The results of the written section will be dispatched by post two weeks after the day of
examination. Candidates who have been successful in the written component will
automatically proceed to the practical components of the examination approximately 8-10
weeks after the written component. Candidates who pass the written component must
proceed to the clinical assessment at the same diet of exams. This cannot be “carried
forward”.

From 2011, candidates who have been unsuccessful in the written component will receive a
35% rebate of the examination fee. This will be automatically calculated and dispatched by
the Finance Department, usually within four weeks of the release of the results for the written
section. This rebate is not available retrospectively to candidates who failed the written
section prior to 2011.

The results of the practical component, and hence overall exam, will be released four weeks
after the final day of examinations once verified by the Senior Examiner. Final results will be
sent to candidates by first class post and the pass list will be displayed on the College website.

Examiners and candidates are not permitted to telephone the College for examination results.




                                                13
Part 2 FRCOphth Examination Syllabus

The Fellowship of the Royal College of Ophthalmologists examinations are designed to assess
the knowledge, skills and professional attitudes required of a doctor who wishes to practise as
an ophthalmologist in the United Kingdom. A pass in the Part 1 FRCOphth, Refraction
Certificate and Part 2 FRCOphth examinations represents a high level of achievement. The
FRCOphth is a necessary but insufficient requirement for the Certificate of Completion for
Training in Ophthalmology.

The three examinations that comprise the FRCOphth are based upon the curriculum for
ophthalmic specialist training and candidates are strongly advised to become familiar with
the curriculum (available at: http://curriculum.rcophth.ac.uk/).


The Part 2 FRCOphth examination consists of three assessment formats:
    written papers (single best answer multiple choice and extended matching questions),
    structured viva and
    objective structured clinical examinations (OSCE).


The Part 2 FRCOphth examination is a synoptic examination that covers all areas of
RCOphth OST curriculum. Those areas of the curriculum where workplace based
assessment has been used as continuous assessment throughout training are less likely to
feature in the written parts of the examination but may be assessed in the structured viva and
objective structured clinical examinations (OSCE).


The syllabus for each part of the examination is intended as a guide only and candidates are
advised that all parts of the ophthalmic specialist training curriculum can be assessed in
all parts of the examination.

Syllabus for the Written Papers                                              Page 15
(patient investigations, patient management and basic and clinical sciences)

Syllabus for the Structured Viva                                             Page 26
(patient management, health promotion and disease prevention, decision making, clinical
reasoning and judgement, information handling, attitudes, ethics and responsibilities)

Syllabus for the OSCE                                                         Page 33
(Clinical assessment, communication)




                                              14
Syllabus for the Written Papers

The specific learning outcomes from the RCOphth OST curriculum that the written part of the
part 2 FRCOphth examination assesses are:

Patient Investigation (PI)
These learning outcomes have already been assessed in the part 1 FRCOphth examination
but as competence in the interpretation of investigations must been maintained it is
appropriate to reassess them in the part 2 FRCOphth examination.

PI1       Orthoptic assessment
          All candidates must be able to refer for an orthoptic assessment, where appropriate,
          and interpret the findings. They must understand the limitations of the investigations
          and the implications of positive or negative test results. They must be aware of the cost
          and resources involved.

         Interpretation and an understanding of the performance underlying basic science of the
          tests that make up a typical orthoptic report, including:
              o Quantitative and qualitative assessment of vision (children & adults)
              o Cover, cover-uncover test and alternate cover test
              o Assessment of ocular movements
              o Measurement of deviation
              o Assessment of fusion, suppression and stereo-acuity.
              o Knowledge of Hess Chart/Lees Screen, field of BSV and uniocular fields of
                  fixation

PI2       Assessment of corneal shape, structure and thickness
          All candidates must be able to order and interpret investigations to assess the cornea,
          although availability of equipment will vary in different units. They must be able to order
          and interpret basic tests. They must be able to interpret more complex investigations
          and be aware of specialised techniques. They must understand the purpose and
          limitations of the investigations and the implications of a positive or negative test result.
          They must be aware of the possible discomfort, distress and risks that the patient may
          be exposed to with the test as well as the cost and resources involved.

         Interpretation and an understanding of the performance underlying basic science of
          contemporary tests that are used in corneal practice, including:
              o Keratometry
              o Corneal topography
              o Pachymetry
              o Optical coherence tomography
              o Specular and confocal microscopy
              o Wavefront analysis


PI3       Retinal and optic nerve imaging
          All candidates must be able to order and interpret retinal and optic nerve investigations
          that require some form of image capture and analysis. They must be aware of new
          techniques as they are developed. They must understand the limitations of the
          investigations and the implications of a positive or negative test result. They must be
          aware of the possible discomfort, distress and risks that the patient may be exposed to
          involved with the test as well as the cost and resources involved.

         Interpretation and an understanding of the performance and underlying basic science of
          contemporary tests that are used in retinal practice, including:
              o Retinal photography
              o Optical coherence tomography
              o Scanning laser ophthalmoscopy

                                                   15
PI4       Ocular angiography
          All candidates must be able to order, describe and interpret ocular angiograms. They
          must understand the purpose and limitations of the investigation and the implications of
          a positive or negative test result. They must be aware of the possible discomfort,
          distress and risks that the patient may be exposed to involved with the test as well as
          the cost and resources involved.

         Interpretation and an understanding of the performance and underlying basic science of
          contemporary angiographic tests that are used in retinal practice, including: Fluorescein
          and indocyanine green angiography

PI5       Ultrasonography
          All candidates must be able to order and interpret appropriate ocular, orbital and other
          relevant ultrasound measurements and images. They must understand the limitations
          of the investigation and the implications of a positive or negative test result. They must
          be aware of the possible discomfort and distress to which the patient may be exposed
          during the test as well as the cost and resources involved.

         Interpretation and an understanding of the performance and underlying basic science of
          contemporary ultrasound tests that are used in ophthalmic practice, including:
              o A and B scans
              o Ultrasound biomicroscopy
              o Doppler ultrasound

PI6       Radiology and other neuro-imaging
          All candidates must be able to order and interpret appropriate radiological and related
          investigations. They must understand the limitations of the investigation and the
          implications of a positive or negative test result. They must be aware of the possible
          discomfort and distress and risks to which the patient may be exposed during the test
          as well as the cost and resources involved.

         Interpretation and an understanding of the performance underlying basic science of
          contemporary tests that are used in radiological practice, of relevance to the practice of
          ophthalmology, including:
              o Plain skull and chest X ray
              o Orbital and neuro-CT scans
              o Orbital and neuro-MRI scans
              o Neuro-angiography

PI7       Ocular and neuro-physiology
          All candidates must be able to order and interpret appropriate electrodiagnostic tests.
          They must understand the limitations of the investigation and the implications of a
          positive or negative test result. They must be aware of the possible discomfort and
          distress and risks to which the patient may be exposed during the test as well as the
          cost and resources involved
         Interpretation and an understanding of the performance and underlying basic science of
          contemporary tests that are used in ophthalmic practice, including:
              o Electroretinography
              o Electrooculography
              o Visually evoked potentials

PI8       Biochemistry
          All candidates must be able to order and interpret appropriate biochemical
          investigations and recognise when further action is required. They must understand the
          limitations of the investigation and the implications of a positive or negative test result.
          They must be aware of the possible discomfort and distress and risks to which the
          patient may be exposed during the test as well as the cost and resources involved.

                                                   16
         Interpretation and an understanding of the performance and underlying basic science of
          contemporary tests that are used in ophthalmic practice, including
              o Liver and renal function tests
              o Blood glucose
              o Cardiac enzymes
              o Acid-base balance
              o Blood gases
              o Thyroid function tests

PI9       Haematology
          All candidates must be able to order and interpret appropriate haematology
          investigations and recognise when further action is required. They must understand the
          limitations of the investigation and the implications of a positive or negative test result.
          They must be aware of the possible discomfort and distress and risks to which the
          patient may be exposed during the test as well as the cost and resources involved.

         Interpretation and an understanding of the performance and underlying basic science of
          contemporary tests that are used in ophthalmic practice, including
              o Clotting screens
              o Blood count
              o Blood transfusion
              o ESR. CRP and blood viscosity

PI10      Pathology
          All candidates must be able to order and interpret appropriate pathology investigations
          and recognise when further action is required. They must understand the limitations of
          the investigation and the implications of a positive or negative test result. They must be
          aware of the possible discomfort and distress and risks to which the patient may be
          exposed during the test as well as the cost and resources involved

         An understanding of the performance and underlying basic science of contemporary
          tests that are used in ophthalmic practice, including
              o Types of biopsy
              o Transport of specimens
              o The law in relation to human tissue

PI11      Microbiology
          All candidates must be able to order and interpret appropriate microbiology
          investigations and recognise when further action is required. They must understand the
          limitations of the investigation and the implications of a positive or negative test result.
          They must be aware of the possible discomfort and distress and risks to which the
          patient may be exposed during the test as well as the cost and resources involved.

         Interpretation and an understanding of the performance and underlying basic science of
          contemporary tests that are used in ophthalmic practice, including
              o Collection of samples for virology, bacteriology, mycology, parasitology
              o Corneal scrapes
              o Conjunctival swabs
              o Intra-ocular samples
              o Sampling for MRSA and other important hospital acquired infections

PI12      Biometry
          All candidates must be able to order and interpret appropriate biometry investigations,
          particularly in relation to decision making in cataract surgery. They must understand the
          limitations of the investigation and the implications of an unusual result. They must be
          aware of the possible discomfort and distress and risks to which the patient may be
          exposed during the test as well as the cost and resources involved.

                                                   17
      Interpretation and an understanding of the performance and underlying basic science of
       contemporary tests that are used in ophthalmic practice, including
           o Keratometry
           o Axial length measurement
           o IOL power calculation
           o A constants
           o Sources of biometric error
           o Choice of post-operative refractive error
           o Refractive error


PI13   Fields (automated, Goldmann)
       All candidates must be able to order and interpret appropriate visual field investigations.
       They must understand the limitations of the investigation and the implications of a
       positive or negative test result. They must be aware of the possible discomfort and
       distress and risks to which the patient may be exposed during the test as well as the
       cost and resources involved.

      Interpretation and an understanding of the performance and underlying basic science of
       contemporary tests that are used in ophthalmic practice, including
           o Humphrey and other automated perimeters and the common forms of statistical
              analysis generated
           o Goldmann perimetry

PI14   Immunology and allergy testing
       All candidates must be able to order and interpret appropriate immunology and allergy
       investigations and recognise when further action is required. They must understand the
       limitations of the investigation and the implications of a positive or negative test result.
       They must be aware of the possible discomfort and distress and risks to which the
       patient may be exposed during the test as well as the cost and resources involved

      Interpretation and an understanding of the performance and underlying basic science of
       contemporary tests that are used in ophthalmic practice, including
           o Auto-antibodies
           o HLA antigens
           o Patch/allergy tests

PI15   Urinalysis
       All candidates must be able to order and interpret appropriate urinalysis and recognise
       when further referral is required. They must understand the limitations of the
       investigation and the implications of a positive or negative test result.

      Interpretation and an understanding of the performance and underlying basic science of
       contemporary tests that are used in ophthalmic practice, including
           o Proteinuria
           o Haematuria

PI16   Bone scans
       All candidates must know when it is appropriate to order bone scans as part of bone
       protection in long term steroid use. They must recognise when action is required based
       upon the report. They must understand the limitations of the investigation and the
       implications of a positive or negative test result. They must be aware of the possible
       discomfort and distress and risks to which the patient may be exposed during the test
       as well as the cost and resources involved..

      Interpretation and an understanding of the performance and underlying basic science of
       contemporary tests that are used in ophthalmic practice, including Dexa-scans

                                                18
Patient Management (PM)
The patient management learning outcomes are assessed in the structured viva, OSCE and
written parts of the Part 2 FRCOphth examination. The following are subjects for assessment
in the part 2 FRCOphth written papers:

PM10 Visual standards
     All candidates must know and be able to interpret the visual standards for driving. They
     must be able to locate published guidance and advise a patient on occupational visual
     standards. They must be able to respond appropriately to requests for information
     about a patient's vision from the relevant authority.

      Basic knowledge and understanding of the visual disorders chapter (chapter 6) of the
       DVLA Guide to the current medical standards for fitness to drive
       (http://www.dvla.gov.uk/media/pdf/medical/aagv1.pdf)


PM13 Systemic implications
     All candidates must be able to recognise when a patient's ocular problem is a
     manifestation of a systemic disorder. They must be able to explain this to the patient
     and make appropriate arrangements for further management.

      Medical retinal disorders including diabetic retinopathy and hypertensive retinopathy
      AIDS–related opportunistic infections
      Cardiovascular disorders relevant to ophthalmology
      Respiratory disorders relevant to ophthalmology
      Rheumatological disorders relevant to ophthalmology
      Skin disorders relevant to ophthalmology
      Endocrine and metabolic disorders relevant to ophthalmology
      Chromosomal disorders relevant to ophthalmology
      Phacomatoses
      Ocular toxicology
      Systemic associations with ophthalmic disease
      Neurological disorders relevant to ophthalmology

PM14 Spectacle lenses
     All candidates must be able to identify when a patient may benefit from the use of
     spectacle lenses and prisms. They must be able to assess the type and strength of lens
     or prism and provide an appropriate prescription. They must be able to liaise with and,
     where indicated, seek advice from optometrists and orthoptists. They must be able to
     advise a patient on the purpose, duration and optical effects of the prescription.

      Correction of ametropia and presbyopia using spectacle lenses
      Monofocal, mulitfocal and varifiocal lenses
      Use of prisms

PM15 Contact lenses
     All candidates must be able to recommend the use of contact lenses when indicated by
     the patient's clinical problem. They must be able to make an appropriate referral and
     make appropriate provision for the patient to be reviewed. They must be able to advise
     on basic contact lens care and be able to recognise and manage the complications of
     contact lens use.
   Types of contact lenses
   Contact lens solutions
   Indications for contact lens use in ophthalmic practice
   The basics of contact lens fitting
   Management of contact lens complications

                                              19
PM18 Diet and nutrition
     All candidates must understand how dietary deficiencies and nutritional problems can
     lead to ophthalmic disease. They must be able manage the patient appropriately, by
     prescription of supplements or referral for expert advice. They must be able to give
     general advice to a patient whose diet may lead to illness. They must be able to advise
     a patient on the role of nutritional supplements in the management of ophthalmic
     disease

       Vitamin deficiency
       Ocular consequences of alcohol, tobacco and drug abuse
       Malnutrition
       Use of nutritional supplements in ophthalmology

Basic and Clinical Sciences (BCS)
Although anatomy, physiology, biochemistry, cell biology, growth, senescence and optics have
been assessed in the Part 1 FRCOphth examination, clinically important aspects of these
learning outcomes may be assessed in the part 2 examination and candidates should prepare
accordingly. The following are subjects for assessment in the part 2 FRCOphth written
papers:

BCS4            Pathology
        All candidates must understand and apply knowledge of pathology, especially the
        specialist pathology of the eye, adnexae and visual system. This includes
        histopathology, microbiology and immunology and other branches of pathology. They
        must be able to use this knowledge when interpreting clinical symptoms, signs and
        investigations and in the practice of ophthalmic medicine and surgery.

        Acute inflammation: Chemical mediators, cellular mechanisms
        Wound healing
        Chronic inflammation: Types, granulomata, immune mechanisms, ulceration
        Immunological mechanisms : Types of hypersensitivity reaction
        Graft rejection
        Degenerations: Examples: amyloidosis, calcification
        Ageing and atrophy
        Hypertrophy, hyperplasia and metaplasia
        Vascular disorders: Atheroma, thrombosis (and homeostatic clotting mechanisms
        embolism (including pulmonary embolism), ischaemia and infarction, congestion and
       oedema, angiogenesis, hypertension, aneurysms, diabetic microangiopathy
        Shock
        Neoplasia: Definition, terminology, concepts; benign and malignant tumours;
        carcinogenesis; gene control – including regulation of apoptosis; oncogenes,
       geographical
        and environmental factors; pre-neoplastic conditions; effects of irradiation and cytotoxic
        drugs




                                                 20
      MICROBIOLOGY:

      The biological and clinical behaviour of the micro-organisms responsible for infections
      Elementary principles of microbial pathogenesis : Concepts of colonisation, invasion,
       endotoxins, exotoxins, virulence and pathogenicity etc.
      Gram staining and classification
      Commensal eye flora
      Viruses: Classification, structure and replication, antiviral agents, laboratory methods of
       viral detection; viral infections of the eye.
      Prions
      HIV and AIDS
      Fungi: Classification, factors which predispose to fungal infection, antifungal agents.
      Toxoplasmosis, Chlamydia, Acanthamoeba, helminth infections
      Principles of sterilization: Disinfection and asepsis and the application of these to
       current practice and practical procedures
      Antimicrobials: Spectrum of activity, mode of action, pharmacokinetics and resistance
      Hospital acquired infection: MRSA, C. difficile

      IMMUNOLOGY

      Principles of immunology e.g. non-specific resistance, genetic basis of immunity,
       cellular and humoral mechanisms
      Host defence mechanisms with particular reference to the eye
      Mechanisms of immunologically-induced tissue damage with special reference to the
       eye
      Role of soluble mediators (cytokines and chemokines) in regulation of inflammatory
       responses
      MHC antigens, antigen presenting cells and antigen processing
      Transplantation immunology (with particular reference to the cornea)
      Immunodeficiency and immunosuppression
      Tissue regulation (with particular reference to the eye) of inflammatory responses)

BCS7          Clinical Ophthalmology
       All candidates must understand and apply knowledge of medicine and surgery relevant
       to ophthalmic practice. They must understand the principles underlying contemporary
       ophthalmic practice and medical and surgical innovations. They must be aware of the
       breadth of ophthalmology and the sub-specialties within ophthalmology.

       The scope of contemporary clinical ophthalmology is broad and the following list is
       indicative rather than exhaustive.

      Orbital disease
          o Clinical anatomy
          o Lacrimal problems – secretory and drainage systems.
          o Orbital inflammation
          o Paranasal sinus disease
          o Orbital neoplasia
          o Orbital malformations
      External eye disease
          o Clinical anatomy
          o Dry eye syndromes
          o Conjunctival infection
          o Conjunctival inflammatory, degenerative and neoplastic disease
          o Scleral and episcleral disease
          o Allergic eye disease
          o Abnormalities of tear film
      Eyelid disorders
                                               21
        o Clinical anatomy
        o Blepharitis and Meibomian gland dysfunction
        o Malpositions: entropion, ectropion and ptosis
        o Lid tumours
   Corneal disease
        o Clinical anatomy, physiology and immunology
        o Keratitis
        o Corneal dystrophies and degenerations
        o Corneal ectasias
   Lens and cataract
        o Clinical anatomy, physiology and biochemistry
        o Cataract
        o Abnormalities of lens shape and position
   Uveal disease
        o Clinical anatomy, physiology and immunology
        o Uveitis
        o Primary and secondary uveal tumours
        o Choroidal effusion
   Medical retinal disease
        o Clinical anatomy, physiology and immunology
        o Vascular retinopathies
        o Macular degeneration
        o Hereditary retinal disease
        o Retinal infection
   Glaucoma
        o Clinical anatomy, physiology and pharmacology
        o Classification of glaucomas
   Ocular motility and strabismus
        o Clinical anatomy and physiology
        o Binocularity
        o Strabismus
        o Myopathies
        o Developmental anomalies of binocularity, including amblyopia
   Neuro-ophthalmology
        o Clinical anatomy and physiology
        o Optic nerve disease
        o Visual pathway disorders
        o Pupil abnormalities
        o Nystagmus
        o Headache
        o Diplopia
        o Ptosis
        o Cranial nerve palsies – particularly IInd, IIIrd, IVth, Vth, VIth and VIIth
   Paediatric ophthalmology
        o Clinical anatomy and embryology
        o Child development and developmental delay
        o Congenital abnormalities
        o Cataract, glaucoma and retinal disease in children
        o Retinopathy of prematurity
        o Non-accidental injury
        o Assessment of the apparently blind baby/child
        o Systemic syndromes
   Intraocular tumours
        o Primary intraocular neoplasia
        o Secondary intraocular tumours
        o Non-metastatic effects of neoplasia
   Surgical ophthalmology
        o Anaesthesia – local and general
                                                22
          o   Surgical anatomy
          o   Sterilization of instruments and equipment
          o   Sutures and other materials used in ophthalmic surgery
          o   Principles of wound design, construction and healing
          o   Principles of wound closure, appropriate use of different suture materials and
              needle design
          o   Intraocular lenses
          o   Management of trauma
          o   Cataract surgery
          o   Endophthalmitis
          o   Surgery for glaucoma
          o   Vitreo-retinal surgery
          o   Strabismus surgery
          o   Oculoplastic surgery
          o   Corneal surgery
          o   Enucleation
          o   Nasolacrimal and orbital surgery
          o   Laser surgery – cornea, iris, vitreous, retina
          o   Complications of surgery – general and specific
          o   Use of human tissue for surgery (eye banking)

      Tropical ophthalmology

BCS8          Therapeutics
       All candidates must understand and apply knowledge of clinical therapeutics relevant to
       ophthalmic practice. They must be able to use this knowledge when prescribing for a
       patient. They must understand the therapeutics used in general medicine and surgery
       to a basic standard. They must be aware of the possible ocular effects of systemic
       medications and systemic effects of ocular medications.

      Principles of ocular pharmacology
      Anaesthetic agents
      Anti-infective drugs
      Glaucoma medication
      Anti-inflammatory drugs
      Lubricants
      Visco-elastics
      Mydriatics and miotics
      Immuno-suppressants and cytotoxic drugs used in ophthalmic practice
      Dyes used in ophthalmology
      Drugs used for retinal and macular disease
      Role of preservatives
      Treatment of diabetes, hypertension, respiratory disease, cardiovascular disease
      Anti-platelet drugs and anti-coagulants
      Side effects of ocular medications
      Ocular side effects of systemic medication

BCS9          General Medicine and Neurology
       All candidates must understand and apply knowledge of general medicine and surgery
       relevant to ophthalmic practice. They must be able to recognise when a patient is
       seriously ill and make appropriate arrangements for the patient's care

  Knowledge, to the level of a newly qualified doctor, is expected in the following areas:
   Sexually transmitted diseases
   Infectious diseases
   Gastroenterology, hepato-biliary and pancreatic disease
   Haematological diseases and medical oncology

                                              23
      Rheumatology
      Renal disease and basic fluid and acid-base balance
      Cardiovascular and respiratory disease
      Endocrinology and diabetes
      Neurological disease
      Dermatology
      Emergency medicine – ability to recognize the ill patient
      Management of acute emergencies – anaphylaxis, hypo/hyperglycaemia, the
       unconscious patient and cardiac and respiratory arrest

BCS10       Psychology
     All candidates must understand and apply knowledge of clinical psychology relevant to
     ophthalmic practice. They must understand the psychology of vision to a basic standard
     and how psychological problems can become manifest with ophthalmic symptoms.
     They must be able to recognise when a patient's mental state is disturbed and make
     appropriate arrangements for the patient's care.

      Psychiatric disorders
      Psychiatric aspects of ophthalmic diseases
      Medically unexplained symptoms
      Alcohol and drug misuse
      Organic mental disorders
      Dementia
      Mental incapacity and consent

BCS11       Sociology
     All candidates must understand and apply knowledge of medical sociology relevant to
     ophthalmic practice. They must understand how social problems can influence
     ophthalmic symptoms. They must be able to refer a patient for appropriate social
     services support.

      Child protection
      Visual impairment
      Social Services Framework
      Driving and vision

BCS12        Laser
     All candidates must understand and apply knowledge of lasers relevant to ophthalmic
     practice. They must be able to use this knowledge when recommending laser treatment
     in the practice of ophthalmic medicine and surgery. They must be fully versed in local
     laser safety procedures.

      Laser physics
      Types of medical lasers of use in ophthalmology
      Biological effects of lasers
      Laser safety

BCS13       Epidemiology/Evidence Based Medicine
     All candidates must understand and apply knowledge of clinical epidemiology and
     evidence based medicine relevant to ophthalmic practice. They must be able to use this
     knowledge during clinical assessment, interpreting investigations and planning clinical
     management for a patient.

      Epidemiological principles
      Screening
      Burden of ocular disease
      Sensitivity, specificity, numbers needed to treat/harm
                                               24
      Best evidence for practice
      Critical assessment of published evidence

BCS14        Instruments
     All candidates must understand and apply knowledge of instrument technology relevant
     to ophthalmic practice. They must be aware of the limitations of technology and the
     risks involved in their use. They must be able to maintain an understanding of new
     developments in relevant technologies

      Surgical instruments
      Instruments used in clinics

BCS15       Statistics
     All candidates must understand and apply knowledge of statistics relevant to
     ophthalmic practice. They must be able to use this knowledge in the interpretation and
     publication of research

      Descriptive statistics (central tendency, dispersion, proportion, confidence intervals)
      Inferential statistics (parametric and non-parametric hypothesis tests, correlation and
       regression, statistical significance)
      Risk (relative and absolute risk, hazard and odds ratios)

BCS16       Genetics
     All candidates must understand and apply knowledge of clinical genetics relevant to
     ophthalmic practice. They must be able to use this knowledge when advising patients
     about patterns of inheritance. They must recognise when it is appropriate to refer a
     patient for genetic counseling. They must recognise when it is important to offer a
     consultation with family members.

      Basic molecular genetics
      Inheritance patterns
      Inherited eye diseases
      Genetic counseling

BCS17       Economics
     All candidates must understand and apply knowledge of health economics relevant to
     ophthalmic practice. They must understand how ophthalmic services are planned and
     managed within the health service.

      Health policy
      Effectiveness of health care interventions
      Econometrics




                                               25
Syllabus for the Structured Viva

This aspect of the exam may explore competence in any of the learning outcomes from
the RCOphth OST curriculum, therefore in addition to the subjects assessed in the written
papers, the following are subjects for assessment in the Part 2 FRCOphth Structured Viva
examination and OSCE:

Patient Management

PM1    Management Plan
       All candidates must be able to formulate a management plan based upon their clinical
       assessment and, where appropriate, the results of relevant investigations. The
       management plan must acknowledge relevant guidelines or protocols and justify when
       these have not been followed. They must be able to recognise when their management
       plan involves a level of expertise that is beyond their own competence

      Differential diagnosis from clinical findings and patient investigation
      Use of evidence based practice, protocols, clinical guidelines
      Explanation of management plan to patient and carers
      Involvement of patient in management decisions
      Monitoring response, identification of complications

PM2    Triage/Prioritisation
       All candidates must be able to recognise when a patient's clinical presentation needs
       priority and make appropriate arrangements to expedite their care. In ophthalmic
       emergencies they must be able to contribute to clinical triage.

      Ocular and medical emergencies
      Clinical leadership

PM3    Therapeutics
       All candidates must be able to prescribe topical and systemic medications safely. They
       must also be able to administer a limited number of systemic therapies by
       subcutaneous, intramuscular, and intravenous routes, where appropriate, and in
       accordance with local and national clinical governance arrangements. They must be
       aware of the indications, contra-indications, side-effects and possible interactions of the
       drugs they prescribe.

      Good prescribing practice
      Use of topical medication
      Use of peri-ocular and intraocular medications
      Use of oral and intravenous medications
      Common side-effects of and contra-indications to ophthalmic therapeutic agents
      Compliance

PM4    Select for surgery
       All candidates must be able to identify patients for whom surgery would be an
       appropriate management option. They must be able to recognise how selection for
       surgery is informed by the patient's unique medical, psychological and social
       circumstances. They must involve the patient, and where appropriate their carer,
       partner or relatives, in the decision and enable them to express their informed consent.
      Indications for surgery in contemporary ophthalmic practice
      Explaining surgery to patients and their carers
      Reasons for withholding or delaying surgery




                                                26
PM5   Prepare for surgery
      All candidates must be able to contribute to the preparation of patients for surgery.
      They must be able to contribute to the pre-operative assessment for local and general
      anaesthesia and recognise their role as part of a multidisciplinary team. It is recognised
      that arrangements vary in different hospitals and clinical environments.

     Standards of consent for surgery (mentally competent and incompetent patients)
     Pre-operative assessments and preparation
     Intraoperative care of the patient
     Postoperative care of the patient

PM6   Assess progress
      All candidates must be able to assess the progress of a patient's condition and respond
      accordingly. This includes observation of the natural history of a disease and clinical
      improvement or deterioration in response to interventions. They must recognise when it
      is appropriate to seek advice from other professionals.

     Natural history of ophthalmic disorders
     Expected responses to treatment (therapeutic and side-effects)
     Adverse incident reporting
     Recognition of role and expertise of others in a multi-professional team

PM7   Complications
      All candidates must be able to recognise when a patient has or is developing a
      complication or side-effect from treatment. They must be able to manage the
      complication in an appropriate and timely manner. They must be able to inform the
      patient, and where appropriate their carer, partner or relatives, in an honest, open and
      sensitive way in accordance with local and national clinical governance arrangements.
      They must be able to comply with local and national arrangements for critical incident
      reporting. They must be able to recognise when complications occur at a higher than
      expected frequency and respond appropriately.

     Recognised common complications of ophthalmic interventions
     Communication of complications to patients and their carers
     Normal reporting mechanisms for complications e.g. cataract complication audit
     Prophylaxis/management of complications
     Action when complication rates reach unacceptable levels

PM8   Emergencies/First aid
      All candidates must be able to initiate management of medical emergencies and offer
      first aid until expert help arrives. They must recognise when the patient's condition
      requires further medical care or intervention and make the appropriate referral.

     Hypoglycaemia
     Diabetic ketoacidosis
     Severe haemorrhage and shock
     Cardiopulmonary collapse
     Anaphylactic shock
     Vomiting
     Severe pain

PM9   Anaphylaxis/resuscitation
      All candidates must be able to manage acute anaphylaxis and perform
      cardiopulmonary resuscitation.

     Angiography anaphylaxis
     Adverse reaction to local anaesthesia

                                              27
      Basic adult life support
      Basic paediatric life support

PM11 Rehabilitation/registration
     All candidates must be able to recognise when a patient might benefit from a low vision
     aid assessment or other rehabilitation services for visual impairment. They must
     understand and be able to apply, in a sensitive manner, the criteria for the completion
     of the Certificate of Visual Impairment or equivalent.

      Certificate of visual impairment
      Basic understanding of support available after registration

PM12 Referral
     All candidates must be able to involve other health care professionals in patient
     management when appropriate. They must be able to make appropriate referrals in a
     timely and efficient manner and in accordance with local protocols and guidelines.

      Recognition of professional limitations
      Appropriate and timely referral

PM16 Refractive surgery advice
     All candidates must be able to recognise when a patient may benefit from surgical
     correction of their refractive error. This may be in addition to the management of
     another ocular problem, particularly cataract. They must be aware of current techniques
     and their limitations. They must be able to recognise and manage the complications of
     refractive surgery.
      Contemporary keratorefractive surgery
      Intraocular refractive surgery
      Complications and their management

PM17 Select for laser
     All candidates must be able to identify when a patient could benefit from laser treatment
     and make appropriate arrangements or provide appropriate advice. They must be
     aware of the different laser techniques available, potential complications and benefits.

      Types of laser in ophthalmic practice
      Indications and contraindications for laser
      Appropriate preparation of the patient, including information, consent and pre-laser
       treatment


Health Promotion and Disease Prevention (HPDP)

HPDP1        Screening
     All candidates must understand the basic principles of screening for disease. They
     must understand the local and national organisation of screening programmes for
     ophthalmic diseases. They must provide local screening programmes with appropriate
     clinical expertise. They must be aware of the limitations and risks of screening.

      Types of screening
      Sensitivity, specificity, likelihood ratio, predictive value, prevalence and incidence
      Ethics of screening
      Management of screening positives and negatives
      Screening programmes for ophthalmic diseases e.g. ROP, diabetic retinopathy,
       neonatal examinations



                                                 28
HPDP2          Contagion and cross infection
        All candidates must adopt appropriate local and national guidance for the prevention of
       cross infection and the control of contagion.

      Hand hygiene
      Management of MRSA and other hospital cross-infection risks
      Management of highly infectious eye diseases e.g. epidemic conjunctivitis
      Blood borne infections
      Needle stick injuries

HPDP3       Notification/contact tracing
     All candidates must make appropriate notification of diseases according to national
     protocols. They must make appropriate arrangements for contact tracing in relation to
     communicable diseases.

      Ophthalmic diseases that require notification e.g. ophthalmia neonatorum
      Liaison with genitourinary medicine departments

HPDP4        Injury prevention
     All candidates must be aware of available resources and information regarding eye
     injury prevention and promote their use when appropriate.

      Eye protectors
      At risk professions/activities
      Eye disorders requiring particular protection

HPDP5        Disease risk reduction
     All candidates must be aware of the implications of ophthalmic disease for the patient's
     general health and well-being and be able to provide appropriate advice

      Cardiovascular risk
      Ophthalmic signs of systemic disease
      Contemporary strategies for risk reduction
      Appropriate liaison with primary and secondary care


HPDP6       Contact lens care
     All candidates must be able to provide basic advice on contact lens care, with particular
     emphasis on the prevention of infection. Trainees wishing to specialise in contact lens
     practice must agree further learning goals with their educational supervisor.

      Types of contact lens, storage and solutions
      Common problems associated with contact lenses and their prevention

HPDP7       Care of laser and diagnostic contact lenses
     All candidates must understand the proper use of laser and diagnostic contact lenses
     and how they should be cleaned and cared for.

      Prevention of cross infection
      Appropriate cleaning and storage
      Signs of damage

HPDP8        Avoidance of allergens
     All candidates must be able to provide basic advice for patients in how they may be
     able to manage their condition by avoiding allergens or other triggers that cause
     relapses and exacerbations.


                                               29
         Common allergens
         Simple strategies for reduction of allergen exposure

HPDP9       Immunisation
     All candidates must be aware of local and national immunisation policies and be able to
     implement them in appropriate circumstances. They must understand the risks, benefits
     and limitations of immunisation

         Management of tetanus prone injuries
         BCG
         Awareness of other vaccination regimes (The Green Book)

HPDP10       Investigations and therapeutics during pregnancy
     All candidates must understand and take appropriate steps when assessing,
     investigating and recommending treatment for a pregnant woman. They must know that
     investigations and treatments may have possible adverse implications for the woman
     and her unborn child.

         Important teratogens
         Risks associated with the use of medications and diagnostic agents during pregnancy

HPDP11      Bone protection
     All candidates must be able to provide appropriate advice and treatment for the
     prevention of steroid induced osteoporosis.

         Assessing risk of osteoporosis
         Simple prophylaxis measures
         Indications for bone density scans and specific osteoporosis treatment

HPDP12      Prophylaxis
     All candidates must be able to take measures for the prevention of disease by using
     appropriate prophylaxis. In particular they must follow local and national guidance on
     the prevention of surgical infection.

         Prophylaxis for endophthalmitis and wound infections during surgery
         Best evidence/guidance on antibiotic use in prophylaxis
         Other prophylactic measure relevant to ophthalmic practice e.g. migraine, IOP rises
          with some procedures, herpes simplex infection

Information Handling (IH)

IH3       Guidelines
          All candidates must be aware of and be able to use local and national guidelines.

         Important guidelines of relevance to ophthalmology e.g. RCOphth guidelines
          http://www.rcophth.ac.uk/about/publications

Decision Making, Clinical Reasoning and Judgment (DMCRJ)

DMCRJ1     Reasoning
    All candidates must be able to demonstrate that they can make decisions by applying
    appropriate and clear clinical reasoning. They must be able to apply the principles of
    evidence based practice.
   Basis of clinical reasoning
   Hierarchy of evidence for practice
   Evidence based practice


                                                 30
DMCRJ2     Departmental audit
    All candidates must participate in departmental audit. They must understand how audit
    can contribute to improvement in clinical practice. They must be prepared to implement
    the changes recommended by an appropriately conducted departmental audit.

      Principles of audit
      The audit cycle
      Planning and executing an audit project
      Ethics and legal aspects of clinical audit
      Clinical governance
      Recognition and management of poor outcomes or clinical practice


DMCRJ3     Personal audit
    All candidates must participate in personal audit. They must understand how audit can
    contribute to improvement in their own clinical practice. They must maintain appropriate
    audits according to national policy.

      Professional requirements for audit
      Acting on audit results
      Confidentiality and declaration of audit results
      Recognition and management of poor outcomes or clinical practice

DMCRJ4      Research
    All candidates must understand the basic principles of research in medicine. They must
    be able critically to appraise research and to understand how the findings contribute to
    clinical practice

      Research methods
      Research ethics
      Planning and executing a research project
      Data collection and analysis
      Critical appraisal of published research-‘How to read a paper’

DMCRJ5      Service management
    All candidates must understand the basic principles of how health services are
    managed at a departmental, hospital, community and national level.
   Ophthalmology as part of a managed health service
   Principles of health service organisation and funding
   Clinical directorates

Attitudes, Ethics and Responsibilities (AER)

AER5          Confidentiality
       All candidates must respect patient confidentiality. They must be aware of appropriate
       circumstances for disclosure of patient information

      Professional standards of patient confidentiality
      Situations where confidentiality can be broken

AER12       Legal (Duties of a doctor)
     All candidates must understand and apply a legal duty of care to patients in accordance
     with the GMC's guidance, the Duties of a Doctor.
   Duties of a doctor and Good Medical Practice




                                               31
AER13       Data protection
     All candidates must be able to apply the principles of data protection and freedom of
     information legislation in relation to the use and disclosure of health data.

      Awareness of legislation regarding the protection of clinical data

AER14       Human Tissue
     All candidates must be able to apply the principles of legislation in relation to the use of
     human tissue and how it applies to ophthalmic practice.

      Familiarity with important legislation regarding the use of human tissue in ophthalmic
       practice
      The ethics of tissue donation for teaching, therapeutic uses and research

AER 15       Child Protection
     All candidates must understand and be able to apply the child protection legislation in
     relation to ophthalmic practice. They must recognise when a child may require
     protection and be able to take action using appropriate local measures to secure the
     child's safety.

      Recognition of a child at risk
      Social, legal and medical networks for child protection

       Communication with patients
       Communication with colleagues
       Dealing with relatives
       Awareness of legal matters/dealing with requests for information from police, lawyers
       etc




                                               32
Syllabus for the OSCE

This aspect of the exam may explore competence in any of the learning outcomes from
the RCOphth OST curriculum, therefore in addition to the subjects assessed in the written
papers and Structured Viva), the following are subjects for assessment in the Part 2
FRCOphth OSCE:

Clinical Assessment (CA)

The candidate must demonstrate the ability to perform a comprehensive, appropriate and
competent clinical examination and deal with the patient in a caring and understanding way.

CA1    Clinical History
       All candidates must be able to take a clinical history from a patient, which is appropriate
       for the clinical problem and the individual patient's needs.

      Appropriate start to interview
      Good listening skills
      Appropriate use of open and closed questions
      Relevant questioning e.g. drug, family history, systemic enquiry
      Sensitive to patient’s needs
      Aware of barriers to good communication
      Able to summarise important negative and positive findings
      Appropriate conclusions drawn from history

CA2    Assess vision
       All candidates must be able to assess visual acuity for near and distance using an
       appropriate method and interpret the results. They must be aware of and be able to
       interpret and apply newer methods of assessing visual acuity when they are introduced
       into clinical practice. They must be able to test colour vision using an appropriate
       method and interpret the results. They should also know the principles of the
       assessment of contrast sensitivity. They must be able to assess vision in children and
       in adults who have language and other barriers to communication. They must be able
       to assess vision in circumstances outside the OPD environment.

      Snellen and LogMAR acuities
      Near acuity
      Acuity testing in children, non-English speaking or reading individuals and those with
       mental impairment
      Colour vision testing
      Contrast sensitivity
      Potential acuity in presence of cataracts

CA3    Confrontation visual fields
       All candidates must be able to make an assessment of normal and abnormal visual
       fields using an appropriate confrontation method. They must then be able to interpret
       any abnormality and the possible causes. They should be aware of the reliability of this
       method of visual fields assessment and know when to arrange for more detailed visual
       field analysis.

      Appropriate confrontational technique
      Appropriate use of coloured targets
      Interpretation of findings and recommendation for further testing




                                               33
CA5   External eye examination
      All candidates must be able to perform an examination of the external eye, ocular
      adnexae, eyelids and orbits using appropriate equipment and illumination. They must
      be able to modify the examination and utilise other techniques as indicated by the
      clinical findings

     Observation using torch, palpation, auscultation
     Exophthalmometry
     Assessment of lid position
     Lid eversion
     Interpretation of findings and recommendation for further testing


CA6   Pupils
      All candidates must be able to assess the pupil for abnormalities of shape, size,
      equality and reactions and interpret their findings. They must also be able to perform
      and interpret appropriate pharmacological tests for specific pupil abnormalities

     Anisocoria
     Direct and consensual reflexes
     Swinging torch test
     Near reflex
     Light/Near dissociation
     Pharmacological assessment of pupils
     Dark reflex
     Interpretation of findings and recommendation for further testing


CA7   Ocular motility and cover test
      All candidates must be able to perform a cover test, assess ocular movements and
      interpret the findings. They must be able to perform a prism cover test. They must also
      be able to recognise and describe nystagmus if present

     Examination of eye position: cover test, alternate cover test, prism cover test
     Examination of eye movements: ductions, version and vergence, smooth pursuits,
      saccades, dolls head, OKN
     Assessment of concomitant and incomitant strabismus
     Amblyopia
     Nystagmus
     Assessment of binocular function and Stereopsis
     Interpretation of findings and recommendation for further testing



CA9   Slit lamp
      All candidates must be able to examine the eye and adjacent structures using the slit
      lamp and interpret their findings. They must be able to employ all of the functions of the
      slit lamp and use accessory equipment when indicated. They must know how to care
      for the equipment properly and prevent cross infection.

     Assessment of lids, conjunctiva, cornea, anterior chamber, iris, pupil, lens and anterior
      vitreous
     Assessment of anterior chamber angle using a variety of lenses
     Mastery of the slit lamp: illumination techniques, magnification, use of eye pieces
     Familiarity with portable slit lamp systems
     Assessment of the intraocular pressure
     Interpretation of findings and recommendation for further testing
                                              34
CA10 Fundus examination
     All candidates must be able to examine the fundus of the eye using appropriate
     techniques and interpret their findings. They must be able to use the direct and indirect
     ophthalmoscopes. They must be able to use a variety of lenses for binocular fundus
     examination with the slit lamp. They must be able to use appropriate indentation
     techniques.

      Assessment of the vitreous, retina, choroid and optic nerve using;
           o the direct ophthalmoscope
           o the indirect ophthalmoscope with a variety of lenses and indentation techniques
           o the slit lamp with a variety of lenses
      Interpretation of findings and recommendation for further testing


CA11 General medical examination
     All candidates must be able to perform a basic medical examination and understand
     the importance of their findings so as to be able to know when a patient is ill and
     requires appropriate referral.
   Proficiency in general medical assessment is tested at the level expected of a
     foundation year 1 trainee (newly qualified doctor), including assessment of
         o Cardiovascular system: heart, carotid arteries, peripheral pulses, perfusion,
            blood pressure
         o Respiratory system: breath sounds, cyanosis
         o Abdominal examination
         o Lymphadenopathy
   Interpretation of findings and recommendation for further testing


CA12 Paediatric/developmental
     All candidates must be able to perform a basic assessment of a child's developmental
     milestones and recognise when it is appropriate to seek a paediatric opinion..

      Basic developmental testing (major milestones in the first 5 years of life)
      Signs of neglect or abuse
      Signs of neuro-developmental delay
      Interpretation of findings and recommendation for further testing


CA13 Neurological examination
     All candidates must be able to perform a basic neurological assessment with particular
     emphasis on the cranial nerves. They must be able to recognise when serious
     neurological problems are present that requires the opinion of a neurologist. They must
     be able to recognise neurological emergencies.
   Proficiency in general medical and neurological assessment is tested at the level
     expected of a foundation year 1 trainee (newly qualified doctor), including assessment
     of
         o cranial nerves
         o motor function in limbs (tone, power, reflexes including plantar responses),
         o sensory function (light touch, vibration sense, proprioception)
         o coordination/cerebellar function
         o brief mental state assessment
   Interpretation of findings and recommendation for further testing




                                               35
CA14 Examination of neck
     All candidates must be able to perform a basic examination of the neck and recognise
     when further referral is appropriate.

        Examination of anterior and posterior triangles
        Assessment of neck movement
        Basic assessment of oral cavity and airway
        Interpretation of findings and recommendation for further testing

CA15 Examination of skin and joints
     All candidates must be able to perform a basic examination of the skin and joints and
     recognise when referral on for dermatology or rheumatology opinion is required.

        Examination of skin
        Examination of joints, in particular hands and upper limb
        Interpretation of findings and recommendation for further testing

CA16 Differential diagnosis
     All candidates must be able to formulate and justify an appropriate differential diagnosis
     for a patient as part of the management plan. They must be able to identify the most
     likely diagnosis and initiate management. They must consider the common conditions
     as well as the rare, but important conditions in the differential diagnosis

        Summary of all relevant negative and positive clinical findings
        Justification of differential diagnosis
        Strategy to refine diagnosis
        Development of management plan


C1       Rapport
         All candidates must be able to establish a trusting relationship with a patient, their
         carers and relatives. They must be able to recognise when there could be problems
         with establishing rapport and make attempts to mitigate possible effects on the clinical
         relationship.

C2       Listening
         All candidates must be able communicate effectively and sensitively. They must be
         able to demonstrate active listening throughout a consultation. They must be sensitive
         during questioning and be able to draw the consultation to a satisfactory conclusion.


C3       Deliver information
         All candidates must be able deliver information clearly to a patient and, where
         appropriate, their carers and relatives; this must include including the explanation of a
         diagnosis and its treatment options using appropriate terms. They must be sensitive to
         how the information is given and how it is being received. They must allow a patient to
         determine how much information they want and how quickly it should be shared. All
         trainees must provide information using appropriate terms and be sensitive to issues of
         ethnic, gender and religious diversity.

C10      Professionals
         All candidates must able to communicate succinctly and effectively with other
         professionals as appropriate. They must be able to use verbal, written and electronic
         means of communication. They must respond to legitimate requests for information in a
         timely manner.




                                                 36
The Royal College of Ophthalmologists
17 Cornwall Terrace, London. NW1 4QW.
Telephone: 020-7935 0702
Facsimile: 020-7487 4674
Email: exams@rcophth.ac.uk
Website: WWW.RCOPHTH.AC.UK


Application form for the Part 2 FRCOphth Examination

Candidate Number:

Last name of candidate:

Other names in full:

Full postal address:




Telephone Number: Home                                      Work

Email Address:

Date of Birth:

Medical Qualifications with dates:

University or Medical College:

Country of Qualification:
I am registered with the GMC in UK/Ireland        YES/NO
I have:
Full Registration          Limited Registration 

GMC Number:

If you have sat this examination on a previous occasion please state the number of times you have
sat this examination: ____________

Date of Passing Part 1 FRCOphth (after 1 October 2006)

Date of Passing Refraction Certificate

Date of Passing Part 2 MRCOphth

Date of Passing Part 3 MRCOphth

Date of Passing Part 2 MRCSEd in Ophthalmology
by examination (attested confirmation attached)

Date of Passing Part 3 MRCSEd in Ophthalmology
by examination (attested confirmation attached)

There is no specific training requirement to enter this examination but candidates are unlikely to
successfully complete this examination without a significant period of training in ophthalmology.




                                                  37
Candidates in Ophthalmic Specialist Training:

Candidates who are in ophthalmic specialist training (OST) must supply evidence that they are undertaking OST
and provide confirmation of the year they are in. Please be aware that details of your result will be forwarded to
your Training Programme Director.

Year of Commencing OST:

Current Year of OST:

Please select your Deanery:
                                                          Tick                                        Tick
 East Midlands (North)                                           South Yorkshire & South
                                                                 Humberside
 East Midlands (South)                                           Wessex Institute
 East of England                                                 West Midlands
 Kent, Surrey and Sussex                                         Yorkshire
 London (NW & NE Thames & Moorfields)
 Mersey                                                          Northern Ireland
 Northern                                                        Wales
 North Western                                                   East of Scotland
 Oxford                                                          North of Scotland
 Severn Institute                                                South of Scotland
 South West Peninsula                                            West of Scotland

Please ensure your application complies with College Regulations. Examination closing dates are available on
Page 9 of this Application Pack or online at http://www.rcophth.ac.uk/exams/dates.

The fee for sitting the Part 2 FRCOphth is £850.00. Please make cheques payable to ‘The Royal College of
Ophthalmologists’. Alternatively, Visa and Mastercard are accepted. If you wish to use this method of payment,
please complete your details below.

This application form must be returned to the Examinations Department, The Royal College of Ophthalmologists,
17 Cornwall Terrace, London, NW1 4QW, together with the fee and documentation.

Please note it is not possible to accept application forms after the closing date for receipt of applications.

Applicants are advised to send applications forms by Special Delivery or Recorded Post to guarantee delivery.

Allocation will be on a first come, first served basis and although there is not a limit on numbers, venues can only
hold a specified amount of people due to health and safety.

         I hereby apply to be admitted to the Part 2 Fellowship Examination of the Royal College of
          Ophthalmologists. I confirm I shall be available to sit the Written Component on 7 February 2011 in
          London and, if successful in the Written Component, I shall be available to attend the Practical
          Component of the examination in Middlesbrough from 4 to 7 April 2011. I enclose the fee of £850.00*.

         I hereby apply to be admitted to the Part 2 Fellowship Examination of the Royal College of
          Ophthalmologists. I confirm I shall be available to sit the Written Component on 6 September 2010 in
          London and, if successful in the Written Component, I shall be available to attend the Practical
          Component of the examination in Aylesbury from 8 to 12 November 2010. I enclose the fee of £850.00*.

Signature of Candidate:

Date of Application:



Details for Card Payment (this section is detached and destroyed once payment is processed)

Name of Cardholder:

Card Number:                                                                            Security Code (CSV):

Expiry Date:                                Start Date:                                 Issue Number:

                                                          38
Monitoring of Equal Opportunities

The Council of The Royal College of Ophthalmologists would be grateful, although it is not
compulsory, if you would help the College to monitor equal opportunities within its
Examinations by answering the following questions and submitting the completed form with
your Examination Application. The ethnic groups used are those recommended by the
Equality and Human Rights Commission.

NAME OF EXAMINATION CANDIDATE: ………………………………………………

SEX OF EXAMINATION CANDIDATE:                       □    MALE □         FEMALE

ETHNIC BACKGROUND OF EXAMINATION CANDIDATE:

Please choose one selection from (a) to (h) then tick the appropriate box to indicate your
cultural background:

a)     White
□      British
□      English
□      Scottish
□      Welsh
□      Irish
□      Any other white background, please specify…………………………………

b)     Mixed
□      White and Black Caribbean
□      White and Black African
□      White and Asian
□      Any other mixed background, please specify………………………………...

c)     Asian, Asian British, Asian English, Asian Scottish or Asian Welsh
□      Indian
□      Pakistani
□      Bangladeshi
□      Any other Asian background, please specify…………………………………

d)     Black, Black British, Black English, Black Scottish or Black Welsh
□      Caribbean
□      African
□      Any other Black background, please specify…………………………

e)     Chinese, Chinese British, Chinese English, Chinese Scottish or Chinese Welsh
□      Chinese
□      Any other Chinese background, please specify…………………………

f)     Other ethnic group
□      Other, please specify………………………………………………

□      Decline to Answer

Do you consider yourself to have a disability according to the terms given in the
Disability Discrimination Act 1995 (DDA)?
□ Yes         □ No

FIRST SPOKEN LANGUAGE OF EXAMINATION CANDIDATE: ……………………



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