Everything You Need to Know About FRCS (Ophthalmology)

Do you want to be an Ophthalmologist in the UK? If so, you will need to familiarise yourself with the FRCS (Ophthalmology) qualification. FRCS (Ophthalmology), a Diploma of Fellowship of the Royal College of Physicians and Surgeons, is a highly regarded award that shows your competence in Ophthalmology, allowing you to manage patients on an individual level. You can also use this qualification to get on the GMC register, which means you can work as a doctor in the UK. 

Naturally, these exams are demanding and rigorous, and you will only get through them with enough experience and preparation. Using this guide, you can learn everything you need to know about FRCS (Ophthalmology), helping you clear the exams the first time. 

Who is FRCS (Ophthalmology) For?

FRCS (Ophthalmology) is a high-level qualification for IMGs who want to prove their skills, experience, and clinical competencies in Ophthalmology. It is a GMC-recognised postgraduate qualification that enables you to start your NHS career at a higher level – although, do keep in mind that it’s not a direct entry into higher specialty training. Often, you’ll need NHS experience as an IMG before you can enter specialty training in Ophthalmology.

In some cases, IMGs may even use FRCS (Ophthalmology) to back up their CESR/Portfolio Pathway application, allowing them to get on the specialist register. Do keep in mind that this is a very challenging pathway – only Consultant doctors with extensive experience should take this route! 

FRCS (Ophthalmology): Eligibility and Cost

The FRCS (Ophthalmology) exams are only open to individuals who meet certain criteria, with the criteria becoming more specific for the later exams. Each FRCS (Ophthalmology) part also comes with a fee. 

FRCS (Ophthalmology) Part 1

Cost: £450

To sit FRCS (Ophthalmology) Part 1, you need a primary medical qualification (accepted by GMC) and to have completed one year of an internship and one year of clinical experience post-internship. The experience does not have to be in Ophthalmology. 

FRCS (Ophthalmology) Part 2

Cost: £640

For FRCS (Ophthalmology) Part 2, you need to have passed part 1. You will also need five years of clinical experience, with at least 54 months of those five years being in clinical Ophthalmology. 

FRCS (Ophthalmology) Part 3

Cost: £1645

To sit FRCS (Ophthalmology) Part 3, you must have passed parts 1 and 2 (in cases where you are not exempt). 

Exemptions from FRCS (Ophthalmology)

Some qualifications exempt you from having to take particular FRCS (Ophthalmology) examinations. If you have any of the following qualifications, you may be exempt from part 1 and be able to move straight on to part 2 FRCS (Ophthalmology):

• FRCSEd Ophthalmology Part 1
• MRCSEd Ophthalmology Part 1
• FRCSEd Ophthalmology Part 1 
• FRCSI (Ophthalmology) Part 1
• MRCSI (Ophthalmology Part 1 
• FRCOphth Part 1
• MRCOphth Part 1
• Basic Sciences or Visual Sciences AND Optics and Refractions or Optics, Refractions and Use of Instruments 
• FC Ophth (SA)
• Diploma in Ophthalmology
• M.Med (Ophthalmology)
• Fellowship in Ophthalmology
• MD (Ophthalmology) Module IV OR M.Med (Ophthalmology) OR MD (Ophthalmology) Part 2

If you have the following qualifications, you may be exempt from Part 2:

• Clinical Sciences or Clinical Ophthalmology

FRCS (Ophthalmology) Exam Locations

FRCS (Ophthalmology) Part 1 and 2

FRCS (Ophthalmology) Part 1 and 2 examinations are held twice per year and take place online using Practique, meaning you can take them from anywhere in the world. 

FRCS (Ophthalmology) Part 3

FRCS (Ophthalmology) Part 3 takes place in certain test centres worldwide, and these locations change from time to time. In 2023, the locations included Amman, Cairo, Delhi, and Mumbai. Going into 2024, these locations may differ depending on where most of the candidates are based. 

How to Apply

For FRCS (Ophthalmology) exams, you can apply online on the Royal College website, where you will find the application form. For FRCS (Ophthalmology) Part 3, you’ll be asked to complete an online survey as part of your application, which involves expressing your interest in sitting the exam. You will have a window of opportunity to submit your application – the process opens and closes on a set date. It’s important to get your application complete and in on time. You should also note that these examinations work on a first-come, first-served basis, so it’s a good idea to apply for each exam soon after the application window opens to avoid disappointment. Once you have applied, you will receive a notification of your place via email. 

FRCS (Ophthalmology) Exam Structure

Knowing what to expect from each exam is critical to passing. Below, we will lay out the exam structure of FRCS (Ophthalmology) parts 1, 2, and 3. 

FRCS (Ophthalmology) Part 1: Multiple-Choice Paper

FRCS (Ophthalmology) Part 1 is a multiple-choice paper that lasts two hours. The test involves 160 single-best-answer questions, all of which have five potential answers. There is no negative marking here, so it’s important to answer every question! Each correct answer grants you one mark, so there are 160 marks available in total. In terms of syllabus, there is 25% weighting for each of the following:

• Anatomy 
• Physiology
• Pathology
• Embryology, Pharmacology, Cell Biology & Biochemistry, Genetics, and Optics

FRCS (Ophthalmology) Part 2: Multiple-Choice Paper

Like FRCS (Ophthalmology) Part 1, Part 2 is a multiple-choice examination with single-best-answer questions that have five potential answers each. For this exam, candidates get a total of two and a half hours to answer the 180 questions. Again, there is no negative marking, so it makes sense to leave no question unanswered, and each correct answer gives you one mark (so there’s a total of 180 potential marks). This exam covers the following: 

• Eyelids 
• Cornea
• Disorders of Lacrimal Drainage
• Conjunctiva
• Ocular Inflammatory Disease
• Glaucoma
• Cataract
• Intraocular Tumours 
• Acquired Macular Diseases
• Retinal Vascular Disease
• Hereditary Fundus Dystrophies
• Orbits
• Strabismus
• General Medicine
• Medical Emergencies

FRCS (Ophthalmology) Part 3: Structured Oral Examination and Clinical Examination

The FRCS (Ophthalmology) is quite different from parts one and two; instead of being a written exam, FRCS (Ophthalmology) Part 3 is split into two practical examinations. It comprises of a structured oral examination and a clinical examination. Both are to be taken on the same day. 

Structured Oral Examination

The structured oral examination involves two examiners asking you – the candidate – a set of questions. It’s split into three sections, each lasting twenty minutes. This is what each section covers:

1. Lids, Oculoplastic, and Anterior Segment
2. Posterior Segment and Glaucoma
3. Neurology, Motility, and General Medicine

For each of the three sections, you’ll be met with two examiners. One examiner will ask questions for ten minutes, and then the other examiner will ask different questions for the remaining ten minutes. Some questions may include images. Regarding marking of the structured oral exam, you will be given a mark from six of the examiners. 

Clinical Examination

The clinical examination is split into four sections, each lasting twelve minutes. This is what the four sections cover (keeping in mind that they can be in any order on the day):

1. Anterior Segment Disorders
2. Posterior Segment Disorders
3. Neuro-ophthalmic and Ocular Motility Disorders
4. Oculoplastic and Lid Disorders

During the clinical exam, you will rotate between four rooms, where you will complete each 12-minute section. The exam itself involves a clinical scenario - you’ll be asked to examine two to three patients per room while discussing findings with both the patient and the examiner. Overall, you’ll meet with eight examiners in total, all of which will give you a mark. 

How to Prepare for FRCS (Ophthalmology) Exams 

It’s important to prepare for the FRCS (Ophthalmology) exams. Even if you’re preparing for FRCS (Ophthalmology) part two and have years of Ophthalmology experience, you still need to focus your studies on the syllabus to ensure you cover all subjects. To help you prepare, here are some handy tips:

Come Up with a Study Plan

Don’t expect to be able to cram for these exams – they are challenging, and you’ll need plenty of time to prepare for them. Devising a study plan is the best way to ensure you have enough time to cover the entire syllabus. For these exams, at least two months of preparation is recommended. 

Take Mock Exams

Mock exams of FRCS (Ophthalmology) parts 1, 2, and 3 are beneficial, as you’ll get used to the exam format and learn the best ways to answer. For the practical exam (part 3), ask a colleague or mentor to practise with you and ask them for feedback - even better if they have taken the FRCS (Ophthalmology) exams themselves! 

In a pinch, answering example FRCS (Ophthalmology) questions can really help you familiarise yourself with the exam format. Answer these questions whenever you can throughout the day. 

Time Yourself

Practising exams and past questions is good, but it’s even better to do so under the same time pressure you’ll be under on the day. These exams are time-bound, and you won’t do well if you spend too long on one section. So, to prepare for each exam, practise questions and mock exams while timing yourself. The more you do it, the better you’ll become. 

Follow All Instructions

Whether reading a question on the exam day or the guidelines of an examination, always follow instructions to a tee. They are there for a reason, and they are the bare minimum of what is expected of you. For example, if you’re asked to show up wearing sleeves no longer than the elbows, be sure to do so. 

Look After Yourself

No matter how much work you put into preparation for FRCS (Ophthalmology), you can’t compromise your own health. It’s very easy to challenge yourself too far and become overwhelmed to the point where your health is impacted. By staying healthy and giving yourself enough breaks, you have a better chance of clearing the exams, anyway! Spacing out your studies and making time for yourself can really make a difference here. 

Best Materials for FRCS (Ophthalmology) Preparation

If you’re preparing for the FRCS (Ophthalmology) examinations, you’ll know just how important investing in suitable study materials is. You want to get resources that match the core curriculum to ensure your studies stay on track. Here are our recommendations for materials that will help you cover the whole curriculum in your studies:

• Clinical Optics by Elkington, A., Frank, H. and Greaney, M
• Ophthalmic Surgery: Principles and Techniques by Albert, D. 
• Kanski’s Clinical Ophthalmology, 9th Edition by John F. Salmon
• Robbins Basic Pathology by Kumar, V., Abbas, A. and Aster, J. 
• A Manual of Systematic Eyelid Surgery by Collin, J. 

Remember that you want your materials to cover all bases, including pharmacology, ophthalmology basic sciences, ophthalmic surgery, anatomy, optics, and more. A single book cannot cover it all. 

Tips for Passing FRCS (Ophthalmology) on the Day 

So, you’ve studied hard, and the day has finally come when you’re taking parts 1, 2, or 3 of the FRCS (Ophthalmology) examinations. You’ve worked hard, so you can’t let yourself down now. While a big part of clearing these exams comes from adequate preparation, you must also know how to act on the day to give yourself the best possible chance of success. Here are our tips for passing FRCS (Ophthalmology) on the day:

Show Up Over-Prepared

You can never be over-prepared when it comes to FRCS (Ophthalmology) examinations. For parts 1 and 2 that take place online, you should get on the server early, ensuring your laptop/computer and internet connection are not experiencing any issues. For FRCS (Ophthalmology) Part 3, plan your route beforehand and get there early. Wearing the appropriate outfit (smart casual with sleeves above elbows) and bringing lunch with you are also crucial for the exam day to run smoothly. 

Answer All Questions

For FRCS (Ophthalmology) parts one and two, you should answer all the questions given to you – even the ones you don’t know the answer to. That’s because there is no negative marking, so even if you don’t know the answer, you still have a one-in-five chance of getting it right. 

Return to the Questions You Don’t Know

If you come across a question that stumps you, don’t dwell too long on it, as you could use that time to answer questions you do know! Remember, for FRCS (Ophthalmology) parts 1 and 2, every question offers the same number of marks (one), so don’t prioritise any question above another. If you’re struggling on one, flag it and return to it later when you’ve answered the questions you are sure of. Doing this is a great way to maximise the time given. 

Manage Your Time

During each exam, it’s crucial to manage your time, ensuring that you give enough time and attention to each section without overdoing it. The practice part of the revision can really help with this. For example, a mock exam of FRCS (Ophthalmology) part 3 will help you know how much time you should spend with each patient in the clinical examination. 

Read the Questions Carefully

It might sound simple, but it’s an important point to make. When you have 160 questions in front of you (as you will for part 2), you may get a little overwhelmed and rush. Don’t do this! Instead, read the questions carefully, ensuring you understand them fully and enabling you to answer with more confidence. 

Keep Calm and Collected

You’ve made it this far, so breathe! When you’re at the point where you’re walking through the door of the FRCS (Ophthalmology) exam, there is no more time for studying, so you must trust in the preparation you have done. Keeping calm and collected will really help you at this time, as it will enable you to tackle each question and station with confidence, in turn increasing your chances of success. 

What Happens if You Fail FRCS (Ophthalmology)?

These exams are challenging. Sometimes, you put all your effort into studying and preparation, and you still don’t get the marks required to pass the exam. In this case, it’s important not to feel too defeated, as you have the opportunity to retake the examinations. You get a total of six attempts per exam. 

Of course, that doesn’t mean you should aim to take FRCS (Ophthalmology) six times! Especially considering each one requires a fee. If you fail one of the exams, consider speaking with your Educational Supervisor to understand your weaker areas and how you can strengthen your chances of passing the next time. 

What Happens if You Pass FRCS (Ophthalmology)?

Have you passed FRCS (Ophthalmology)? Well done! They are not easy to pass – you need many years of experience to stand a chance, and even then, you need to put in a lot of studying time to clear them. The first thing you should do is congratulate yourself! 

Once you have cleared all three parts of FRCS (Ophthalmology), you can join one of the Royal Colleges of Surgeons, helping you further your professional development. You can also use FRCS (Ophthalmology) to get on the GMC register and get started in an Ophthalmology position in the UK.

In Summary

If you are interested in working in the UK as an Ophthalmologist, the FRCS (Ophthalmology) award is definitely one you should look into. Not only is it recognised by the General Medical Council, but it’s also a qualification that proves your ability to work as a general Ophthalmologist on an independent level. Of course, getting to that point is hard – the exams themselves are difficult, and you’ll need at least five years of clinical experience to complete them in full. To clear these exams, you’ll need to be dedicated and hard-working, as well as willing to put in the many years that are required.