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Ophthalmology is often considered to be an elite, highly competitive specialty, with little room for failure. Candidates and trainees tend to cultivate a certain urbane and confident style, and the bottleneck at ST1 can feel rather intense. The majority of candidates each year will fail.

The following article contains some practical advice, experience and some reflections which I hope will be of interest to prospective candidates and anyone involved in the recruitment process. Ophthalmology is in many ways a beautiful specialty, from the subject matter to the daily practice. It’s important to try and see beyond the crucible of ST1 application and keep your mind on why you want to be an ophthalmologist.

Case study

I applied to the ST1 2020 intake and received an ‘appointable’ score of 215.5/300. I was ranked 98th; there were 71 jobs available for that year. As the focal point of my career at that time dissipated into thin air I felt initially rather downcast. Whichever way you look at it, at that point you have ‘missed the target’, at least for the time being. Some words from the interview course I had attended became bitterly relevant at this point: ‘an appointable score means nothing’. All was not lost though, and what follows may be of help to the prospective applicant in seeing where I fell short. 


Figure 1.


What worked well

1. Picking up ‘easy’ marks

There are parts of the application process which do not require luck, cunning or excellence, but rather only time and effort. It is up to the candidate to determine these marks and then aim to receive as many points as possible (Figure 1). For my year of intake these included the interest in specialty section, audits/QI, multisource feedback and portfolio layout. For example, anyone should be able to get on the surgical simulator and complete the required hours free of charge, not doing so will unnecessarily put you at a disadvantage.

2. Finding a mentor

I was coached through the process by a good friend who was at that time an ST1; he allowed me to see his portfolio layout and gave me some excellent strategic advice about where to invest my time (for example, interview preparation, as opposed to spending months revising for the Multi-Specialty Recruitment Assessment (MSRA). It’s also very helpful to have a friend in training to get their thoughts and experiences about the actual job itself.

3. Finding a practise partner

Equally important is finding a prospective partner who is also going for ST1. I had two excellent practise partners, together we would spend quite a bit of time purely on interview simulation, preparing targeted scenarios for each other over skype or in person and giving each other time to practise. Although I didn’t get in, both of them did, and I really felt it helped at interview.

4. Interview course

Not essential, and expensive, but I do think that it was reasonably useful. I attended the Northern ST1 course. The lectures were quite good and the interview circuits were very valuable.

What didn’t work well

5. Publication, publication, publication

Although I expended a lot of time through FY1 and 2 trying to get published, and submitted six times, I was never successful. I think where I went wrong is twofold. Firstly, I should have started earlier. In hindsight there were lots of excellent opportunities to publish at my university – I did not take these at the time – if you are reading this at medical school, get involved now. Secondly, I was not strategic enough in who I tried to publish with. Unfortunately, academia is sometimes about being wise enough to choose the right time, place and especially person; candidates should keep this in mind. It’s a lot of points lost and that is probably what decided it for me.

6. Communication

I did not do well on my communication skills station at interview, despite practising a lot. The scenario involved apologising to a patient in a clinic setting and dealing with several complicating issues. It is something I practised a lot; nevertheless, it’s difficult to sincerely apologise in a hotel room in Bristol in front of two expressionless consultants, and the feedback did not give me much to go on. I went on to score full marks in the communication skills station at PACES, which has gone some way to heal the wound. One suspicion I have is that I over practised, perhaps becoming too formulaic and thinking too hard about ‘saying the right thing’, whereas during PACES I just acted as I naturally would have in clinical practice – I think this served me better.




1.Necessary pragmatism 

On the one hand, the prospective candidate should look at pragmatically and systematically tailoring their career towards ST1 application, knowing that it is a significant hurdle that, once overcome, will not have to be repeated. Strategy is key and, to an extent, one must accept that for a short period, there must be an intense devotion to collecting the portfolio evidence and honing your interview skills to the detriment of the rest of your life.

There is not a great deal of hard evidence to go on, but for what it’s worth Das et al analysed 1350 candidates between 2012-18 and found that positive predictive factors in securing an ST1 post in ophthalmology include youth, decile performance at medical school, attending a highly ranked medical school, and passing the part 1 FRCOphth examination before applying [1]. Ethnicity doesn’t appear to play a part, to the credit of the Royal College of Ophthalmologists, unlike at Foundation School application [2]. The influence of the Duke Elder examination on successful application seems to be more uncertain [3]. 

2.Think deeper, and relax

On the other hand, I would advise that the candidate thinks carefully about what they want to achieve from life, and tries not to get too swept up in the competitive tidal wave that is ST1 application. Bear in mind that you may be a consultant for 30 years, the longest and most stable stretch of your career, therefore you must select your specialty wisely. 

The ophthalmology trainees I know that are doing best and thriving are the ones that genuinely have a love for the basic science or the daily practice of ophthalmology. They tell me about interesting cases they have seen or enjoyable interactions with patients. They also recount notable difficulties and downsides of the job – that’s important too. It’s an obvious truism but there are upsides and downsides to any job, no job is a safe haven of ease and enjoyment. Think carefully about what is important to you. 

As for me, I did not immediately apply again, but took some time working in general medicine. I do not see this as time wasted; I have made some great friends, completed my MRCP and gained a lot of valuable medical knowledge and experience. The time has made me realise that I still love ophthalmology and would like to apply, but perhaps to the medical side. I hope that prospective candidates are able to find their path in life, and I wish everyone reading this success in their applications to ophthalmology or elsewhere.



1. Das A, Smith D, Mathew RG. Predictors of ophthalmology career success (POCS) study. BMJ Open Ophthalmol 2021;6:e000735.
2. Kumwenda B, Cleland JA, Prescott GJ, et al. Relationship between sociodemographic factors and selection into UK postgraduate medical training programmes: a national cohort study BMJ Open 2018;8:e021329.
3. Joshi L, Shanmuganathan V, Kneebone R, et al. Performance in the Duke-Elder ophthalmology undergraduate prize examination and future careers in ophthalmology. Eye 2011;25:1027-33.




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Lutfi Al-Nufoury

Blackpool Teaching Hospitals NHS Trust, UK.

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