When is the best stage of training to sit the Fellowship of the Royal College of Ophthalmologists Examinations

Sir,

The Royal College of Ophthalmologists (RCOphth) offers examination deadlines, therefore leaving when to best sit these examinations to trainees. The Fellowship Part 1 must be obtained before entering the third year of ophthalmic specialist training (OST).¹ The Refraction Certificate must be obtained before OST4.¹ The Fellowship Part 2 Written and Oral examinations must be obtained before completion of OST.¹

Obtaining the Part 1 before entering OST is considered during OST recruitment and therefore those attempting to enter OST are incentivised to sit the examination. Whilst in OST, examinations can prevent trainee progression; therefore, timing of sitting exams is a source of debate. Colloquially early sittings give a chance of failure and late sittings give a reduced time window to re-sit if necessary.

We have analysed RCOphth examination reports to study what stage candidates take examinations and are more likely to be successful.²

202 Part 1 candidates were successful from 426 (47.42%) attempts October 2012–May 2016 (when Foundation year 2 doctors were separated in statistics), with January 2015 unavailable; Figure 1a. Those who sat Part 1 in OST1 and OST2 were significantly more likely to pass than those in FY2 (P=0.01, χ²).

Figure 1

(a) Fellowship Part 1 Percentage Pass Rate by Training Grade; FY2 n=169, ST1 n=145, and ST2 n=112. (b) Refraction Certificate Percentage Pass Rate by Training Grade; OST1 n=86, OST2 n=103, and OST3 n=126.

244 Refraction candidates were successful from 315 (77.46%) attempts December 2012–March 2016 (when the examination changed to the current format), with April 2013 unavailable; Figure 1b. There was no association between grade and pass rate (P=0.99, χ²).

380 Part 2 Written candidates were successful from 541 (74.71%) attempts February 2013–June 2016 (when the examination changed to the current format); Figure 2a. There was no significant association between grade and pass rate (P=0.34, χ²).

Figure 2

(a) Fellowship Part 2 Written Percentage Pass Rate by Training Grade; OST3 n=19, OST4 n=87, OST5 n=200, OST6 n=161, and OST7 n=67 (OST1 3 attempts 0% pass rate and OST2 4 attempts 75% pass rate are not displayed on the graph. (b) Fellowship Part 2 Oral Percentage Pass Rate by Training Grade; OST4 n=13, OST5 n=47, OST6 n=61, and OST7 n=37.

114 Part 2 Oral candidates were successful from 154 (74.03%) attempts November 2014–April 2016 (when the examination changed to the current format); Figure 2. Although those who took the exam in ST6 were most likely to pass (83.61%), this did not reach significance (P=0.07, χ²).

Most candidates took the Fellowship Part 1 exam in Foundation Year 2 (169, 39.7%), Figure 1; however, at this stage candidates have a significantly lower chance of passing the examination. Nevertheless, those that are keen to enter OST and feel prepared should not be discouraged from taking the examination.

We did not find any association between training grade and passing the Refraction Certificate, likely because refraction is a practical skill not associated with OST stage.

Most candidates sat their Part 2 Written in ST5 (200, 37.0%) and Oral in ST6 (61, 39.6%). We did not find any statistical difference between training grade and passing the Written component. There was potentially a trend towards significance for sitting the oral examination in OST6.

We do not account for candidates resitting examinations and we do not account for ophthalmology experience outside OST, two weaknesses of our study. However, the data does provide a useful insight into current pass rates and indicates that most trainees attempt examinations in a timely fashion, benefits of OST are seen in Part 1 pass rates and may be seen in Part 2 Oral pass rates.