Candidate 166

FRCOphth Part 2

Centre:   UK

   Date:    Nov 2012


Run over 2 days with 4 different sessions in total (morning and afternoon) – the topics and questions changed each time so we couldn’t cheat.
I had the following
PM1 – retinal tear, detachment discussion about management
PM2 – Granulomatous uveitis and weird FFA – most people said VKH – discussion about steroids etc

Attitudes/Ethics/Responsibility – Odd discussion about how to look after a blind woman in clinic (i.e. giving her your arm when walking her in), then CVI questions
Audit/Screening/Research – Discussion about screening services, diabetic programme. Glaucoma trials chat – OHTT mainly
Investigations – Hess chart, 4th nerve
Communication skills – Monovision and unhappy patient after cataract surgery

Overall in this viva there is no time whatsoever and the examiners rush you through trying to get all the tick boxes ticked to get you the most marks. However you feel they want to pass you and its over very quickly.
I suspect however the viva is the source of poor pass rate for non-UK trainees – as they either
a) Didn’t realize they might be asked about Caldicott guardians, European working time directives etc
b) Havent gleaned ways to answer those kinds of questions after years of crap in the NHS and at medical school



A pool of 10-15 patients for each station so you end up having one or two shared over the two days but mainly cant tell whats coming up.

Glaucoma/Lids – Cupped disc and chat about glaucoma, BCC on lid .

Cataract/Ant Segment – DSEK post-phaco, Macular dystrophy, Crocodile Shagreen.

Posterior Segement – nanophthalmos/uveal effusion, optic disc pit and macula SRF, retinal coloboma by indirect.

Orbit/Strabismus – Simple left exotropia discussion about Botox/Sx, Brown’s syndrome.

Neuro/Medicine – cerebellopontine angle patient – cranial nerve exam, Adies pupil, inferior quadrantanopia fields, Parkinsons upper limb neuro exam.

Overall there was very little time per case and the examiners were once again nice basically saying – look at the disc/macula/cornea for 30secs-60 secs describe as go along and then discuss for 2-3 mins.

However the Strab/Orbit station was more difficult – apart from the fact its strab/orbit you are left on your on free rein and have more opportunity to dither, which I did. The Medicine/Neuro station was difficult and stressful, partly because the examiners have more time so can just leave you to get on with it and hang yourself with poor technique and partly the personalitys involved – your friendly cornea surgeon is impressed you can identify Macula dystrophy and the adnexal surgeon just wants you to say you won't operate on his Browns patient. But the neurologist is more likely to do what he did with me….

Enter room….patient sitting there next to couch which had entire plethora of neuro testing equipment on it. “Imagine your called to see this man on the medical ward because he is complaining of a headache…off you go” Me – "can I ask him any questions" – “No, and don’t talk as you go along”.
Frankly I felt this was unfair, I have been in such a situation many times on the ward and completed a full assessment taking my time but under extreme pressure with a 5 minute time limit this was a nightmare and if I do fail it will probably be down to that one station and one examiner who decided to put us under unnecessary pressure.


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