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The Royal College of Ophthalmologists fundus
The Royal College of Ophthalmologists Part 2 MRCOphth Examination Candidate Information Pack THE ROYAL COLLEGE OF OPHTHALMOLOGISTS PART 2 MEMBERSHIP EXAMINATION EXAMINATION STRUCTURE 1) Eligibility of Candidates A medically qualified candidate will be eligible to sit the examination provided that he/she a) holds a medical qualification approved by the General Medical Council for the purpose of registration; b) has passed the Part 1 Membership Examination OR Part 1 Fellowship Examination; c) has completed one year‟s full-time training (or equivalent) in ophthalmology. 2) Examination content a) Applied visual optics and theory and practice of refraction b) Clinical methods of examination The content of the examination will be based on the Examination Syllabus of the Part 2 Membership Examination as detailed below. Candidates should be familiar with the syllabus as well as the following documents: Guide to Basic Specialist Training in Ophthalmology 1999 (Training Committee, Royal College of Ophthalmologists) Curriculum of Basic Specialist Training in Ophthalmology 1999 (Training Committee, Royal College of Ophthalmologists) Good Medical Practice GMC EARLY APPLICATION IS ADVISED AS CANDIDATE NUMBERS MAY BE RESTRICTED 2 THE ROYAL COLLEGE OF OPHTHALMOLOGISTS PART 2 MEMBERSHIP EXAMINATION EXAMINATION SYLLABUS PHYSICAL OPTICS Properties of light Electromagnetic spectrum Wave theory Particle theory Diffraction Interference Resolution Polarisation Scattering Transmission and absorption Photometry Lasers GEOMETRIC OPTICS Reflection Laws of reflection Reflection at a plane surface Reflection at curved surfaces Refraction Laws of refraction (Snell‟s Law) Refraction at a plane surface Refraction at curved surfaces Critical angle and total internal reflection Prisms Definition Notation of prisms Uses in ophthalmology (diagnostic and therapeutic) Types of prism Spherical lenses Cardinal points Thin lens formula Thick lens formula Formation of the image Vergence power (dioptric power) Magnification Spherical decentration and prism power Lens form Astigmatic lenses Cylindrical lenses Maddox rod Toric lenses Conoid of Sturm Jackson‟s cross cylinder 3 Notation of lenses Spectacle prescribing Simple transposition Toric transposition Identification of unknown lenses Neutralisation Focimeter Geneva lens measure Aberrations of lenses Correction of aberrations relevant to the eye Duochrome test CLINICAL OPTICS Optics of the eye Transmittance of light by the optic media Schematic and reduced eye Pupillary response and its effect on the resolution of the optical system (Stiles-Crawford Effect) Visual acuity Contrast sensitivity Catoptric images Emmetropia Accommodation Purkinje shift Pinhole Ametropia Myopia Hypermetropia Astigmatism Anisometropia Aniseikonia Aphakia Accommodative problems Insufficiency Excess AC/A ratio Refractive errors Prevalence Inheritance Changes with age Surgically induced Correction of ametropia Spectacle lenses Contact lenses Intraocular lenses Principles of refractive surgery Problems of spectacles in aphakia Effect of spectacles and contact lens correction on accommodation and convergence Effective power of lenses Back vertex distance Spectacle magnification Calculation of intraocular lens power Presbyopia 4 Low visual aids High reading addition Magnifying lenses Telescopic aids - Galilean telescope CLINICAL REFRACTION Retinoscopy Subjective refraction Measurement of BVD Muscle balance tests Accommodative power Measurement of IPD Decentration of lenses and prismatic effect Best form lens Prescribing multifocal lenses Prescribing for children Cycloplegic refraction INSTRUMENTS Direct ophthalmoscope Indirect ophthalmoscope Retinoscope Focimeter Simple magnifying glass (Loupe) Lensmeter Automated refractor Slit-lamp microscope - including methods of examination Stereo-tests Keratometer Applanation tonometer Specular microscope Operating microscope Zoom lens principle Corneal pachometer Lees screen/Hess chart Synoptophore Goldmann perimeter Humphrey perimeter Lenses used for fundus biomicroscopy (panfunduscope, Goldmann lens, Hruby lens, 90D lens, etc.) Fundus camera Gonioscope OSE Focimetry Lens identification Lens transposition Calculations – focal length lens decentration Ray diagrams Prescribing for children Contact lens fitting Interpupillary distance 5 Fluorescein angiography CT/MRI scans, plain X-rays etc Ultrasound scans (A and B scans) Electrodiagnosis Hess charts/orthoptic reports Interpretation of laboratory reports Corneal topography Biometry Colour vision Visual fields Interpretation of Goldmann or Humphrey field testing OSCE CLINICAL METHODS Pupil reactions Visual field testing/interpretation ** Ocular motility (including ptosis, nystagmus, cover test + prism bar) Exophthalmometry Ophthalmoscopy – direct and indirect Use of slit lamp and lenses Retinoscopy (model eye) NOTE: ALTHOUGH THIS SYLLABUS IS REASONABLY EXHAUSTIVE, CANDIDATES MAY BE ASKED ABOUT TOPICS OF RELEVANCE TO OPTICS AND REFRACTION AND TO CLINICAL METHODS OF EXAMINATION WHICH ARE NOT LISTED. ** Candidate should note they may be asked to perform either a Goldmann or Humphrey visual field and should be familiar with the apparatus. They should also be prepared to interpret visual fields from this equipment. October 2000 6 Form of the examination The examination involves 4 sections: 1. A Multiple Choice Question Paper of 60, 5 stem questions, over a 2 hour period The questions will be divided as follows 30 clinical methods questions 30 optics questions 2. An Objectively Structured Examination (OSE) in clinical methods including optics. There will be 8 stations with 5 minutes allocated to each station. A ninth station will be included at the end of the examination as a “rest station”, 5 minutes will be allocated to this station and candidates are advised to check back over their work. 3. An Objectively Structured Clinical Examination (OSCE) in clinical methods including optics in which patients will be involved. There will be 8 stations with 5 minutes allocated to each station. Hand Washing: candidates and examiners are required to wash their hands after seeing each patient. 4. A practical examination in refraction Candidates will spend 30 minutes with the patient in the company of the examiners, 2 clinical ophthalmologists CANDIDATES ARE UNLIKELY TO PASS THIS EXAMINATION UNLESS THEY HAVE HAD EXPERIENCE IN PRACTICAL REFRACTION. THE PRACTICAL REFRACTION AND THE OBJECTIVELY STRUCTURED CLINICAL EXAMINATION MUST BE PASSED. 7 Guide Notes for Candidates In order to successfully complete the Part 2 MRCOphth examination, candidates should demonstrate their knowledge, not only of optics and practical refraction, but also methods of clinical examination of the eye. These skills are tested theoretically by a traditional multiple choice question paper and also, more importantly, by practical examination through the Objectively Structured Clinical Examination (OSCE) and a traditional Practical Refraction Examination. The Objectively Structured Examination (OSE) The unmanned OSE consists of eight stations where each candidate spends five minutes at each station. At each station there is a set task to do which is specifically set out on a provided question paper. Four of these stations will be optics related e.g. draw a ray diagram, and four will be clinically orientated e.g. comment on a particular investigation such as a C.T scan. There will be no examiners present apart from in a supervisory role and a bell will ring after each five minute period to indicate a move to the next station. Candidates will remain seated when they finish their eighth station and five minutes will be timed - candidates will be advised to spend this five minute “rest period” checking over their work. The Objectively Structured Clinical Examination (OSCE) Introduction The OSCE consists of a series of strictly timed assessment „stations‟, where various areas of competence are tested by examiners using an objective marking scheme. Its primary strength is to increase the reliability and validity of the examination by offering a uniform marking scheme for examiners and consistent examination standards for candidates. A pair of examiners is responsible for two stations and each pair will conduct the examination at each of the two stations. At six of these stations, there will be a specific clinical task to perform on a patient such as assessment of pupil reactions. The other two stations will be concerned with clinical optics and may or may not have patients to examine. Structure of the Objectively Structured Clinical Examination The examination will consist of a series of eight stations, each of which will be timed for precise periods of 5 minutes. All candidates will visit every station, the order in which this occurs will vary. The stations are set out as follows: Station 1 Direct Ophthalmoscopy Station 2 Indirect Ophthalmoscopy Station 3 Pupils Station 4 Ocular Motility Station 5 Slit Lamp Station 6 Visual Fields Station 7 Optics Station 8 Optics 8 Usually two examiners will be present at each station for the duration of the cycle. The start and finish of each station is controlled by a timekeeper and clearly signalled. However it is the duty of the examiners to maintain careful timekeeping and they must not over-run the time allocation for each station. Conduct of the Objectively Structured Clinical Examination Conduct of the Examination The timekeeper will announce the commencement of the station. The candidate will remain standing beside the station. One examiner will take the candidate to the station and instruct the candidate on the task required for the first station. After or during examination of the patient, the candidate will be asked to describe his/her findings. At the end of the five minute session, the timekeeper will signal the end of the station. The second examiner will take the candidate to the second station and ask the candidate to examine the next patient. At the end of the second five minute session the timekeeper will signal the end of the station. The candidate will leave the station and be directed to the next station. 5 minutes will be allowed for changeover and for examiners to independently complete the mark sheets. Emphasis is placed on method and clinical examination and ability to elicit clinical signs. Timetable An example of the timetable for a cycle of the examination is set out below. Please ensure you arrive at the examination centre in good time and report to the Candidate Waiting Area. Example timetable: Pair 1 Direct 09:00 Candidate 1 09:15 Cand 4 09:30 Cand 3 09:45 Cand 2 Indirect 09:05 Candidate 1 09:20 Cand 4 09:35 Cand 3 09:50 Cand 2 Pair 2 Pupils 09:00 Cand 2 09:15 Cand 1 09:30 Cand 4 09:45 Cand 3 Ocu. Mot 09:05 Cand 2 09:20 Cand 1 09:35 Cand 4 09:50 Cand 3 Pair 3 Slit Lamp 09:00 Cand 3 09:15 Cand 2 09:30 Cand 1 09:45 Cand 4 Fields 09:05 Cand 3 09:20 Cand 2 09:35 Cand 1 09:50 Cand 4 Pair 4 Optics 09:00 Cand 4 09:15 Cand 3 09:30 Cand 2 09:45 Cand 1 Optics 09:05 Cand 4 09:20 Cand 3 09:35 Cand 2 09:50 Cand 1 At each station the examiner will remind the candidate of the time available and the signals used to indicate the timing. Each candidate must receive their full allocated period of 5 minutes for each station, even if this means that there are periods of silence or waiting, candidates should remain at the station. 9 Practical Refraction Introduction The Practical Refraction Examination takes 30 minutes. At the end of which the candidate should have refracted the patient using both objective and subjective means and produced an appropriate prescription for both distance and near vision. Muscle balance testing should also be done where appropriate. An appropriate answer sheet is provided for candidates with spaces for the relevant findings and must be filled in accurately. The examiners should observe the refraction process and not interject during this time, allowing the candidate to finish the examination without interference. The answer sheets should be taken up by the examiners at the end of the 30 minute period and be used to base the final mark upon. Structure of the Practical Refraction Examination The examination will consist of a 30 minute practical examination in refraction. Two examiners will be present for the duration the examination. The start and finish of each station is controlled by a timekeeper and clearly signalled. Conduct of the Practical Refraction Examination Conduct of the Examination The Examinations Staff will direct the candidates to their appropriate examination rooms. Examiners should receive the candidate and have approximately 5 minutes to assist the candidate in familiarising themselves with their environment, the workings of the equipment provided, location of light switches and so forth. The examiner should also remind each new candidate of the time available and the signals used to indicate the timing. It is vital that the timing of the station is strictly adhered to. The candidate must receive their full, allocated period of 30 minutes for each station, even if this means that there are periods of silence or waiting, candidates should remain at the station. Once the candidate has signalled that they are happy to begin, examiners must notify the Examinations Staff and wait for the timekeeper to announce the commencement of the station to ensure each candidate is equally timed. The examination duration is 30 minutes. After 15 minutes has elapsed, the timekeeper will signal and examiners should inform the candidate that they are halfway through the allocated time period. When 25 minutes has elapsed, the timekeeper will again signal and examiners should inform the candidate that they have 5 minutes remaining. At the end of the thirty minute session, the timekeeper will signal the end of the examination. At this point the candidates should have completed the prescription form in a manner that he/she would give to the patient to take to an optometrist. 5 minutes will be allowed for changeover and for examiners to independently complete the mark sheets. 10 Method of Assessment Objectively Structured Clinical Examination 16 mark sheets in total will be completed for each candidate by the examiners i.e. two examiners per station, 8 stations. The marks awarded on all 16 mark sheets will determine the candidate‟s overall Clinical result. The marks are recorded on a six point grading system ranging from 3 to 8 and are detailed on the mark sheet. The OSCE component will be marked out of a total of 128 marks (the maximum possible from the 16 mark sheets). The overall pass mark is 92. Practical Refraction Examination 2 mark sheets in total will be completed for each candidate by the examiners i.e. two examiners per station. The marks awarded on both mark sheets will determine the candidate‟s overall Practical Refraction result. The marks are recorded on a six point grading system ranging from 3 to 8 and are detailed on the mark sheet. The Practical Refraction component will be marked out of a total of 16 marks (the maximum possible from the 2 mark sheets). The overall pass mark is 11. Marking system 8 = An exceptional appearance with both Examiners 7 = Pass with better than average performance 6 = Pass 5 = Fail 4 = A poor showing unlikely to be compensated by results from other parts of the exam 3 = A very poor fail unlikely to be compensated by results elsewhere. The Examiners will be expected to provide an explanation of this mark if awarded at the adjudication. THE OBJECTIVELY STRUCTURED CLINICAL EXAMINATION AND PRACTICAL REFRACTION MUST BE PASSED. Important Note: Aggressive or inconsiderate behaviour, physical or verbal, to a patient will invariably result in failure. If this occurs, the examiner should award a clear fail and provide clear comment on reverse of the mark sheet. 11 Standard Setting – Overall Result The following rules will apply: 1) The Objectively Structured Clinical Examination must be passed. (ie a score of 92 or above as detailed above) 2) The Practical Examination in Refraction must be passed. (ie a score of 11 or above as detailed above) 3) A marginal fail in either the MCQ paper or the OSE Paper can be compensated for if a candidate performs well in the OSCE and Practical Refraction sections Equipment For the clinical examinations, the candidate should bring his/her own retinoscope, ophthalmoscope and crossed cylinder. Trial frames and lenses will be provided in the Examination room, but candidates are welcome to bring their own if they so wish. Dress Code Staff, examiners and candidates should wear appropriate attire similar to that worn in the normal clinical environment. Results Results will be released 2 weeks after the final day of examinations, once verified by the Senior Examiner. Candidates are not permitted to telephone the College for examination results. All results will be sent to candidates by first class post and the pass list will be displayed on the College website. Counselling The College places great importance on providing guidance to those candidates whose performance failed to meet the standard to pass the examination. Examiners are asked to provide notes to assist in this process, particularly if there is concern regarding a candidate‟s conduct during the examination (e.g. if the clinical method of the candidate was rough or caused patient discomfort). All those who fail the examination will receive details of the sections they failed. It is essential that examiners write their comments clearly on the reverse of the mark sheets. 12 THE ROYAL COLLEGE OF OPHTHALMOLOGISTS EXAMINATION NOTICE PLEASE MAKE SURE YOU WASH YOUR HANDS OR WIPE YOUR HANDS (WITH ANTISEPTIC GEL/WIPES) BEFORE AND AFTER EACH STATION. WASHING FACILITIES, GEL AND WIPES WILL BE AVAILABLE INSIDE AND OUTSIDE OF EXAMINATION ROOMS. 13
"The Royal College of Ophthalmologists fundus"