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					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




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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




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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


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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




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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.




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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



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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.




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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.




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