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Ophthalmology is one of the most competitive medical specialities in the UK, with 3.74 applicants per place in 2018 [1]. Given the competitive nature of this highly specialised field, medical students who are interested in pursuing a career in ophthalmology should start the process of building their portfolio as early as possible to maximise their chances of securing an ophthalmology training number.

Based on the scoring system for 2020 national recruitment, medical students can score points for their portfolio by focusing on the following five criteria: qualifications, publications, presentations, commitment to career and prizes / awards [2].

Based on the 2020 national recruitment scoring system published on the Severn website, students could theoretically obtain 32 out of 55 points (58.2%) on the portfolio station, solely on work undertaken at medical school [2]. Table 1 describes this breakdown and this article will clarify how these points can be obtained.



The first way students can score points is by taking a year out of medical school to complete an intercalated degree (either a BA, BSc or MSc.) Extra points can be obtained if students complete an MD thesis (two points) or a Doctoral PhD degree (three points.) An intercalated year can also be beneficial as it enables students to have a dedicated block of scientific research, which increases their chances of publishing and presenting, which also counts for points.

For ophthalmology applications, a maximum of 10 points can be obtained from publications. Points are awarded for publications in any speciality and do not have to be ophthalmology-specific. Publications are also beneficial for the Foundation Programme application, where two points are currently awarded for publications with a PubMed ID Number.

In addition to publications, students should try to present their research (ophthalmology or non-ophthalmology related). The aim should be to present at international meetings such as Association for Research in Vision and Ophthalmology, American Academy of Ophthalmology or Royal College of Ophthalmologists (RCOphth) Annual Congress [2]. Presentations at international meetings are higher yield, scoring three points for national recruitment compared to two points for national presentations.

Another important way of scoring points on national recruitment is through showing commitment to ophthalmology. It is recommended to undertake the elective whilst at medical school in a specialist eye hospital, such as Moorfields in London, the Wills Eye Hospital in Philadelphia or St John’s Eye Hospital in Jerusalem. Students should also aim to attend eye casualty or their local eye department in their free time. Having an assigned mentor, such as an ophthalmologist with a strong research interest is recommended, as they can advise students on the clinical and academic aspects of the speciality.

“It is recommended to undertake the elective whilst at medical school in a specialist eye hospital”

Finally, students should aim to sit the Duke Elder Exam. This is a two hour 90 MCQ exam ran annually by the RCOphth focusing on clinical ophthalmology, ocular anatomy, physiology and pathology, as well as genetics of the eye. Two points can be obtained for coming in the top 10% and one point for being in the top 60%. This exam is known to be highly competitive so students should prepare adequately, however, there is no limitation to how many attempts can be undertaken, so students should aim to sit the exam on multiple occasions if they do not rank in the top 10%.

Furthermore, throughout medical school, students should submit applications for national prizes / awards held by the Royal Colleges. The RCOphth, for example, offers two specific awards for undergraduate medical students interested in ophthalmology: The Duke Elder Undergraduate Prize Exam and The Patrick Trever-Roper Undergraduate Travel [3]. Although national recruitment scoring changes on an annual basis by focusing on these five areas, students interested in ophthalmology can greatly improve their chances of being successful in the highly competitive national recruitment process.



1. 2018 Competition Ratios, NHS, 2019 by Health Education England.

2. Severn Postgraduate Medical Education – Portfolio Review. Health Education England, NHS, 2019.

3. Ophthalmology for Medical Students and Foundation Doctors, RCOphth, 2019.

(All links last accessed March 2020)


Declaration of competing interests: None declared.




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Charles O’Donovan

South Thames

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