Ophthalmology ST1 Interview Preparation Guide

(Estimated Read time: 5 minutes)

The ST1 applications are competitive (440 applicants for 75 jobs last year).  But the application process is also incredibly structured.  This means that both portfolio and interviews can be prepared for and that the application process is fair – the more you prepare the more likely you are to succeed.

However, it is not always easy to read between the lines and glean what is expected  So we summarised these insights into broad principles for how to  approach interview preparation with a focus on the 2021virtual format.

The 2021 interview.

Let’s get the elephant in the room out of the way, this year due to the pandemic, the interview will be conducted virtually. 

Whilst previous years contained four stations (clinical, communications, quality improvement and critical appraisal), the deanery have changed this to be only a single station involving a patient consultation with an actor. The interviews are held on the 12th of March 2021.

Taking a step back… How does the interview fit in with the rest of the scoring?

According to the latest 2021 Severn Deanery recruitment guide, these are the total score breakdowns.

  1. MSRA – Maximum of 20 points
  2. Evidence Folder (Portfolio) – Maximum of 50 points
  3. Online Assessment – Maximum of 30 points.

This essentially means the interview accounts for 30% of your total score. 

What do we know about the online assessment? 

This is an excerpt from the Severn Deanery Website: 

“ The assessment will be undertaken using Microsoft Teams.
The assessment will be in the form of a patient consultation and will involve conversing with an actor.  The interview will be up to 10 minutes in length.The process for each candidate including the initial identity checks, assessment and the debrief will take approximately 30 minutes. Candidates will be asked to book a slot through Oriel.  The slots are booked on a first come first served basis.“

Severn Deanery Website

Although brief, this is all the guidance released so far on the application process. We would urge you to keep a very close eye on the webpage, and will be doing so ourselves in case of any updates. 
Pro Tip: We also urge everyone to keep an eye out for the official RCOphth Podcast “Eye to Eye” as they are due to release an episode discussing the ins and outs of the 2021 recruitment soon!

How to prepare for the patient consultation 2021

Whilst the seeming lack of information and sudden change in format can seem daunting, the college really does try hard to make it a fair process, and reward the candidates who are the best prepared. With that in mind, the things that helped us the most and that we think are still key are to :

  1. Practice as much as you can 
  2. Practice with someone you don’t know because that is what you will get in the interview.
  3. Have a partner prepare cases you haven’t seen to see how you respond when you are caught off guard. 

When we prepared for our interviews, we made up stations with each other and reached out to find practice partners. Not everyone has that privilege, and stinterview.com aims at both providing a wide base set of questions to get practicing straight away, and a network to find people to practice with. 

Clinical Knowledge

One of the questions we are getting a lot is – is there going to be clinical knowledge tested? The real answer is that this can’t be known for sure. What we do know however, is: (i) it carried the most weight in previous years; (ii) what was commonly tested and at what level. 

What is the foundational level of knowledge expected?

Previous years have tested discrete clinical knowledge in the form of five question stems – based around a clinical image. Examiners asked very closed questions around each picture shown (for example, this is a snapshot from our question bank – the question is “what is seen here and what is the diagnosis?”).

Our question bank comprehensively covers common conditions featured in previous years. We have tried to make them “capture” the format of previous stations – incorporating things that are commonly tested in the way they are commonly presented. A few trends to note for example for the older formats.

  • Short, objective knowledge – Answers were very closed and concise rather than lengthier explanations. Do not study clinical trials – but instead, make sure to know your basics well. 
  • Systemic associations – Because they were expecting a strong F2 or pre-ST1 candidate, a lot of the scenarios had systemic associations such as…
    • Uveitis with ankylosing spondylitis or inflammatory bowel disease.
    • Retinal vascular problems – with associated systemic risk factors
    • Thyroid eye disease – with antibodies, treatments
  • Basic ophthalmology knowledge – They were not expecting complex, nuanced definitions of conditions like glaucoma or retinal detachments, instead, there was a real focus on things that a competent F2 should not miss – for example a third nerve palsy, a swollen optic disc, or an RAPD. 

How will it be tested this year?

Broadly, there are three ways this can be tested

  1. Explicitly tested at the end of the consultation in the form of a viva (perhaps in the “debrief”)
  2. Tested, but indirectly through the patient asking questions requiring some clinical knowledge
  3. Not explicitly tested at all – the station focuses heavily on communication skills with no required clinical knowledge. 

In reality, we don’t know what the format will be this year. But there are still ways to be smart about your revision. In our question bank, there are all three types of stations  – with accompanying mark schemes, and exam briefs to get you going. 

How should I prepare clinical knowledge this year?

  • Focusing on the high-yield conditions – Because only 1 condition will be tested, we can hypothesis it is unlikely to be a complex, neurofibromatosis or ectopic lens…! It would likelier be something more common like glaucoma, cataracts, or AMD.  
  • Don’t focus only on learning facts, make sure instead that you can articulate that knowledge in simple terms. For example, instead of learning a long list of aetiologies for uveitis, make sure you can explain what it is in plain English (as if to a patient!). Instead of learning the “medical” way of describing steroid drops on a “Reducing regime” and “bloods for HLAB27” – get comfortable with describing these plans in jargon-free language as if to a patient (As that is what you will likely be doing!) 

One good way to practice is to use our knowledge tutor and clinical stations – and make sure you practice explaining the common questions a patient could ask around these. 

Communication Skills

In previous years, communication skills has been an often-neglected station. Although it’s often perceived as a “softer” station, this year the patient consultation promises to test your communication skills front and center. 

Some example stations that have come up in past years

  • Angry patient with a red eye because you have given her preservative containing eye drops – she was upset because you have ruined her wedding photos with her daughter’s wedding! Patients could also be upset due to cancelled appointments or operations, missed or delayed diagnoses, practice the spectrum of handling angry patients!
  • Breaking Bad News – Common tough scenarios included papilloedema (explaining they will need a head scan without freaking them out!), or breaking news that a patient cannot drive anymore or will not get their vision back
  • Managing systemic comorbidities – Blood pressure, diabetes, poor lifestyle choices and how this affects vision. 
  • Explaining a diagnosis (or lack thereof!) – Optician’s or community referrals for various conditions, you have test results and need to explain a diagnosis or discharge a patient.

Whilst none of these stations directly test your factual knowledge, having some clinical knowledge really improves the confidence of your communications station (For example – knowing the DVLA driving guidelines greatly reduces your anxiety that this could come up!). 

Some top tips for the communications station 

  • Practice, practice, practice – Again as above, you can get better by practicing. This is one station where you really reap the benefits of practicing with different people as you will not only get fresh feedback on your approach, but also pick up nice ways different people have learnt to put things. 
  • Record yourself – One benefit of the Zoom era is you can record your own stations, watch yourself and make notes on how you would have handled or phrased things differently.
  • Learn to explain things in simple terms – Avoid jargon at all costs, and learn to explain all the common ophthalmic conditions in plain English. Our markschemes, where appropriate, will give suggested phrases for each scenario. 
  • Watch how other people do it – Candidates using interviewbank.com have access to a network of other people practicing, failing that, Youtube has some amazing videos of GP’s sitting communication-heavy stations – watch these to get into the right frame of mind – we stole quite a few good lines from various candidates on youtube. 
  • Focus on the basics – Keeping things simple in terms of your management plan, on the follow up plan, 

Putting it all together and some general tips…

Putting it all together, hopefully this guide has given you a bit of perspective to the spectrum of clinical and communication things that can be expected of you. We’ve tried hard to adapt to this year’s interview format with our patient consultation stations to get your revision going, but regardless of how you choose to work, there’s really no substitute for putting in the focused work before the interview. Just a few final parting tips 

General advice and interview tips.

  • Familiarise yourself with the recruitment guide – Link here 
  • Book study leave on the day of, and if you can, prior to the interview
  • Make sure you are well rested – if possible, swap out of nights and make sure you come refreshed.
  • Make sure you are appropriately dressed
  • Make sure your camera is set up, with decent lighting and framing, you have a working and clear microphone, and that you have a stable internet connection.
  • Make sure you are familiar with Microsoft Teams – It is free to use on all nhs.net accounts, so make sure you are familiar with how the platform works, and your tech-stack works well with this.