Guide to UK Training in Ophthalmology For Overseas Doctors
The Royal College of Ophthalmologists welcomes to the United Kingdom
overseas doctors who wish to undertake a period of postgraduate training
in ophthalmology. There are a wide variety of ophthalmology training posts
available in hospitals ranging from small district general hospitals to
large university postgraduate teaching hospitals. Training posts may offer
Basic Specialist Training (BST), Higher Specialist Training (HST), Fellowships
or Advanced Subspecialty Training Opportunities (ASTOs). Overseas doctors
visit the UK to train at any of these levels.
The aim of this guide is to provide general information for trainees
who wish to undertake postgraduate training in ophthalmology in the UK
and to introduce more specific information about postgraduate training
posts and the examination structure.
Who is an overseas doctor?
An overseas doctor is a doctor who does not have settled status in the
UK as determined by immigration law. There are separate rules for trainees
who are European Economic Area (EEA) nationals (or hold other enforceable
EC rights) and EEA qualified; they should contact the General Medical Council
(GMC) in the first instance for information.
Why do Ophthalmologists from overseas come to the United Kingdom?
Postgraduate training in ophthalmology in the UK is considered to be
well organised and of high quality. Doctors from abroad come to the UK
in order to:
Planning a Period of Postgraduate Training in Ophthalmology in the United
undertake a period of BST and HST in ophthalmology.
obtain advanced subspecialty training in a particular subspecialty area.
obtain a British postgraduate qualification.
undertake a period of clinical academic research.
In order to undertake a period of postgraduate training in ophthalmology
in the UK, the overseas trainee must:
Registration with the GMC
obtain registration with the GMC.
satisfy immigration procedures.
be appointed to a substantive, recognised and educationally approved post.
Doctors cannot undertake any direct patient care in the UK unless they
are registered with the GMC. This means that they are unable to obtain
any clinical training involving the management of patients without registration.
The GMC, by granting registration, gives doctors the legal status necessary
to undertake professional duties. There are two relevant forms of registration
for overseas doctors:
Most overseas qualified doctors who wish to undertake clinical training
in the UK will need to apply for limited registration. Limited registration
may be granted for a maximum of five years. Doctors granted limited registration
will be restricted to supervised employment in approved training posts.
Applicants for limited registration must meet a number of requirements:
Trainees from overseas who wish to apply for the Dual Sponsorship Scheme
of the Royal College of Ophthalmologists (and exemption from the PLAB test),
please see the Dual Sponsorship Scheme Booklet for further details of the
Scheme (Appendix below) .
have a primary medical qualification accepted by the GMC.
have completed overseas at least one year of general clinical training
or internship (equivalent to the pre-registration year in the UK).
have demonstrated their knowledge of English by achieving a satisfactory
score in the International English Language Testing System (IELTS) examination.
pass the Professional and Linguistic Assessment Board Examination (PLAB)
test, or apply for exemption from the PLAB test to obtain limited registration
through one of the many routes the GMC has approved.
To obtain exemption from the PLAB test please contact the GMC for advice.
If the overseas trainee can meet the Dual Sponsorship Scheme requirements,
the College may recommend to the GMC that the trainee be granted limited
registration with exemption from the PLAB test. The Dual Sponsorship
Scheme is not available to anyone who has attempted the PLAB test.
Non-training posts cannot be held with limited registration from
Full registration allows doctors to undertake any kind of professional
employment so long as there are no immigration restrictions affecting the
type of medical practice they can undertake. After holding a training post
for a certain stipulated period with limited registration, doctors can
apply for limited registration to be converted into full registration.
Full details of this can be obtained from the GMC. It should be noted however
that full registration does not alter permit-free training or immigration
Some overseas doctors who have obtained their primary medical qualifications
from the following universities should contact the GMC direct as they may
be eligible for full or provisional GMC registration without having to
take the PLAB test or use the Dual Sponsorship Scheme:
Medical Schools in New Zealand or Australia
The Chinese University of Hong Kong
The University of Hong Kong
The National University of Singapore
The University of Malaya in Kuala Lumpur (doctors who qualified on
or before 31st December 1989)
The University of Cape Town
The University of Natal
The University of Witwatersrand
The University of the Orange Free State
The University of Pretoria
The University of Singapore
The University of the West Indies
Overseas trainees who wish to take up a postgraduate training post in
the UK must be registered with the GMC and be given permission by the immigration
service to stay in the UK for postgraduate training without requiring a
work permit (permit-free training). In order to qualify for permit-free
training, the overseas trainee must satisfy the following criteria:
Period of permit-free training
the overseas trainee must be a medically qualified doctor.
proof of eligibility for registration with the GMC is required.
the overseas trainee must not have already spent four years in postgraduate
training in the UK (excluding one year as a PRHO).
the overseas trainee must make known his/her intention to leave the UK
on completion of training.
Permission is given for a period of up to three years in the first instance,
after which an application can be made for renewal. Permit-free training
at the BST level is allowable for a maximum period of four years; extension
of permit-free training is subject to the approval of the postgraduate
dean. For HST there is no pre-set time limit for training; the amount of
permit-free time allowed will correspond to training goals and is in addition
to BST time and again this needs the support of the Postgraduate Dean.
Application for permit-free training
Application must be made on the correct application form that can be
obtained from The Application Forms Unit (see address of Immigration and
Nationality Directorate in Appendix to this guide or telephone 00 44 (0)8702410645).
Registration with the police is required for those trainees from overseas
who are not Commonwealth citizens. A passport and two passport sized photographs
should be submitted to a local police station. A fee is charged for such
To obtain a copy of the 'Guide to Immigration and Employment of Overseas
Medical and Dental Students in the United Kingdom' (HSG(97)18), please
write to: Department of Health Distributions, PO Box 410, Weatherby, LS23
7LL, or fax 00 44 (0)1937 845381. Please quote the document code (HSG(97)18)
as well as the title of the Guide.
Medical Services in the United Kingdom
The majority of residents in the UK obtain their medical care from the
National Health Service (NHS), which is funded from National Insurance
contributions (a form of taxation) and is free at the point of delivery.
The NHS provides comprehensive care and everybody resident in the UK has
the right to use it. It is a founding principle of the NHS that care is
provided according to the individual's clinical needs rather than the ability
to pay. Doctors in the NHS are divided into two groups; firstly, General
Practitioners (GPs) who provide primary care and, secondly, doctors working
in hospitals who provide secondary care.
General Practitioners normally work in group practices serving a defined
geographical area. The GP will be the first point of contact for most patients
and, for many disorders, the GP will undertake investigation and treatment.
GPs refer patients who have more complex problems, or who are more acutely
ill, to the local hospital.
There are over three hundred major district general hospitals and teaching
hospitals in the UK which provide a range of hospital services including
accident and emergency services, outpatient specialties, maternity and
paediatric care. Patients are generally referred to the hospital by GPs
but some patients go directly to accident and emergency departments with
acute medical problems or trauma. Similarly, referrals to ophthalmology
departments are usually made by local GPs but some patients with acute
problems may go directly to hospital emergency eye clinics.
A small proportion of the UK population use private medical services
rather than the NHS. There are very few private practitioners in primary
care but many hospital doctors do undertake some private work in addition
to their NHS work. Private patients are generally seen initially by GPs
in primary care and are then referred to a private clinic or hospital.
Most private hospitals do not undertake emergency work but tend to deal
with patients with elective (predominantly surgical) problems. Overseas
trainees cannot work in the private sector as such posts are not Royal
College of Ophthalmologists recognised.
Ophthalmological Services in the United Kingdom
Ophthalmological services in the United Kingdom are organised into primary
and secondary care and the majority of patients who have ophthalmological
problems present first to their GP. The GP may treat minor problems such
as blepharitis or conjuntivitis but will refer other patients either to
an optometrist (if the GP believes the problem to be refractive) or to
the Hospital Eye Service (HES). Individuals who have experienced blurred
vision may decide to consult an optometrist who will prescribe a refractive
correction if this is the cause of visual impairment. If the optometrist
discovers any form of eye pathology he/she is obliged to refer the patient
back to his/her GP who will decide whether referral to the HES is appropriate.
Optometrists do not in general refer directly to the HES unless a very
urgent problem such as a retinal detachment is suspected. Some ophthalmologists,
called Ophthalmic Medical Practitioners (OMPs), undertake refractive work
under the auspices of the NHS usually working in optometrist's premises.
The Hospital Eye Service
The HES provides ophthalmic medical and surgical care in ophthalmic
units in district general hospitals or teaching hospitals. The clinical
teams are led by consultant ophthalmologists working with non-consultant
career grade ophthalmologists, ophthalmic trainees, hospital optometrists,
ophthalmic nurses and orthoptists, and supported by clinical, photographic
and other services. Most district general and teaching hospitals have ophthalmology
services including outpatient clinics, day case surgical facilities and
inpatient ward and operating theatres.
Ophthalmologists in the Hospital Eye Service
Ophthalmologists who work in the HES include those in career (or non-training)
grades, such as Consultants, Associate Specialists, Staff Grade Ophthalmologists
and Clinical Assistants, and those in the training grades. The training
grades include Pre-registration House Officers (PRHOs), Senior House Officers
(SHOs) and Specialist Registrars (SpRs).
Ophthalmology Training Posts
Pre-registration House Officer (Houseman) Training
The PRHO posts are filled by newly qualified doctors who have passed
their final qualifying exams in medicine and are then entitled to provisional
registration with the GMC. They are obliged to work in approved hospital
posts as a PRHO for twelve months and, on satisfactory completion of this
twelve month period, will be recommended to the GMC for full registration.
There are very few PRHO posts in ophthalmology and where they do exist
they are usually combined with another surgical post.
Basic Specialist Training as a Senior House Officer
Most UK graduates who have completed their PRHO posts subsequently obtain
SHO posts in order to fulfil general professional training or the first
stages of training in their chosen specialty. Most overseas trainees who
wish to undergo training in ophthalmology in the UK also undertake a period
of BST in the SHO grade. SHO posts are widely advertised and are filled
in open competition. An exception to this arises when overseas trainees
are placed in SHO posts as part of the Dual Sponsorship Scheme. The tenure
of the SHO post is usually a minimum of six months and posts may often
be extended subject to satisfactory performance. Increasingly, SHO posts
are linked into rotations between different hospitals to give a wider clinical
In ophthalmology, SHO posts are usually undertaken for between two and
three years. Trainees who wish to apply for SpR posts in ophthalmology
must (i) have completed at least two years BST in College approved SHO
posts (ii) have passed the MRCOphth examination or equivalent qualification
by the date specified and (iii) attended a College run Basic Microsurgical
Skills Course, usually within the first four to six months of taking up
an SHO post (for trainees who started Basic Specialist Training after 1
April 2001). Trainees who have met these criteria should apply for a Certificate
of Eligibility for Entry into Higher Specialist Training (CEEHST) from
the Royal College of Ophthalmologists. This certificate is a pre-requisite
for appointment to the SpR grade.
Applying for an SHO post
Full details of Basic Specialist Training are set out in the College BST
guide and curriculum (please see Appendix III).
SHO posts in ophthalmology are generally advertised in the British Medical
Journal (BMJ), the Lancet, Hospital Doctor and other publications. The
most useful publication for looking for job vacancies is the BMJ. This
is available on line (at http://www.bmj.com). Training posts in the UK
are very competitive and applications are made directly to the hospitals
concerned, a short-listing process and a selection interview follows this.
Training posts through the Dual Sponsorship Scheme can be offered through
the above process or given as direct placements. Trainees should only apply
for posts that have educational approval from the Postgraduate Dean and
educational approval from the Training Committee of the Royal College of
Ophthalmologists. It is very important when applying for such posts that
the trainee sends with the application a clear and well presented curriculum
vitae. Once shortlisted, it is important to try and make an appointment
to see the hospital before the interview date and to make enquiries about
the post with the current SHO and other junior staff. A shortlisted trainee
may also wish to make an appointment to see the consultants working in
the department to discuss the post with them.
A panel, which is usually made up of consultant ophthalmologists involved
in the rotation, will interview shortlisted candidates; there may also
be a representative of the Postgraduate Dean. There is usually a lay chairman.
The questions asked will mainly relate to the 'person specification' of
the post and the shortlisted candidate's curriculum vitae, i.e. previous
clinical experience including any research and audit activities and interests
After successful interview, the hospital Personnel Department will make
a formal offer of appointment, make arrangements for salary to be paid
and arrange for the trainee to attend an induction session at the hospital.
The Personnel Department will be able to advise the trainee about the procedure
for obtaining a National Insurance number. Hospital accommodation is often
available. Trainees will also be given an educational supervisor who is
usually the College Tutor. He or she will be able to give advice about
teaching and research within the department and postgraduate courses that
may be useful to attend.
Higher Specialist Training as a Specialist Registrar (SpR)
Training at SpR level involves one or more training placements and potentially
encompasses all of the subspecialty areas in ophthalmology. There are two
types of SpR training; Type I and Type II training.
Type I Training
This is a HST programme of four and a half years, which, if completed
satisfactorily, will entitle the doctor to a Certificate of Completion
of Specialist Training (CCST), which is awarded by the Specialist Training
Authority (STA) on the recommendation of the Royal College of Ophthalmologists.
Entry to Type I training is highly competitive and is open to both UK and
overseas doctors who are in possession of the CEEHST. Trainees who have
been awarded the CCST are recommended for inclusion on the GMC's Specialist
Register and are thus eligible to apply for an NHS consultant post.
Type II Training
Type II training is available to overseas doctors who wish to undertake
a period of training at SpR level in ophthalmology but do not wish to complete
the whole HST programme leading to a CCST. Trainees undertaking Type II
programmes must apply for Fixed Term Training Appointments (FTTAs), which
last for a minimum of six months. It is possible to undertake FTTAs in
different training rotations. FTTAs are available to overseas doctors without
a right of indefinite residence in the UK.
Trainees who wish to convert from a Type II to Type I training must
fulfil the entry criteria for HST i.e. a possession of a CEEHST.
A CEEHST is not required to undertake time in FTTA posts, but time
in an FTTA post cannot count towards HST unless the doctor was in possession
of a CEEHST prior to commencement of the FTTA post.
Appointment to a series of FTTA posts does not lead to the award
of a CCST.
Locum Appointment Training (LA-T)
Overseas trainees who wish to undertake a period in the SpR grade may
also apply for a LAT post. LAT posts are open to any ophthalmologist who
has met the entry requirements for the SpR grade and has obtained a CEEHST.
Trainees who are subsequently appointed to Type I training may have time
in a LAT post counted towards their CCST. For further information on LAT
posts counting towards the award of the CCST, please contact the Education
and Training Department at the College.
Flexible Training Posts
The aim of flexible training is to provide an opportunity for doctors
in the NHS to continue training when they are not able to work full-time.
Part-time training has to meet the same educational requirements as full-time
training, differing only in the amount of time that the trainee spends
in medical activities during the week. The total duration of Type I training
is similar for part-time and full-time trainees i.e. the period to the
CCST is extended pro rata for part-time trainees. Ophthalmologists who
wish to undertake flexible training at SHO or SpR level should, in the
first instance, discuss this with their Postgraduate Dean who will be able
to advise them on the procedure for applying to train flexibly. Overseas
trainees who do not have a right of indefinite residence in the UK can
apply to train flexibly.
Royal College of Ophthalmologists approved Advanced Subspecialty Training
Opportunities (ASTOs) and advertised Fellowship Posts
Full details of Higher Specialist Training are set out in the College HST
guide and curriculum (please see Appendix III).
Approved ASTOs and advertised fellowship posts are offered by training
units on request for specific purposes for periods not exceeding one year.
The Royal College of Ophthalmologists does not arrange such posts and trainees
are requested to communicate with individual units.
Clinical attachments are helpful with orientation and gaining familiarity
with the practice of ophthalmology in the UK and can be arranged by trainees
communicating with hospital consultants directly as the Royal College of
Ophthalmologists does not arrange them centrally. Clinical attachments
are honorary posts and trainees are accepted as observers and hands on
experience is not permitted.
Organisation of Postgraduate Training in the UK Deaneries
Postgraduate ophthalmic training is organised and co-ordinated within
'deaneries' that are based around university medical schools and number
between one and three within any given 'NHS region'. The Postgraduate Dean
has overall responsibility for the appointment funding, employment and
training of SpRs in HST and for establishing training contracts with NHS
Trusts in accordance with national guidelines. In contrast, individual
NHS Trusts are responsible for the appointment and employment of SHOs undertaking
BST. Nevertheless, the Postgraduate Dean provides fifty percent of the
basic salaries of SHOs and one hundred percent of the basic salaries of
SpRs (MADEL budget). The Postgraduate Dean must give educational approval
before SHO or SpR posts can be advertised. The Postgraduate Dean, usually
through an Associate Postgraduate Dean, takes special interest in educational
issues such as flexible training or training for overseas doctors.
The Programme Director is responsible to the Postgraduate Dean for the
overall delivery of HST in the deanery in accordance with College guidelines.
The Programme Director's remit includes preparation and publication of
the prospectus of HST, the devolution of elements of the College HST Curriculum
to individual training units through College Tutors, the equitable allocation
of SpRs to individual training placements, and direct involvement in SpR
appointments and annual (RITA) assessments as a regular member of the deanery
Specialty Training Committee (STC) panels charged with these responsibilities.
College Tutors are responsible to the Programme Director for the delivery
of formal teaching and of specified elements of the HST curriculum within
their units; they also have specific responsibility for the quality of
SHO training locally (in liaison with the Trust Postgraduate Clinical Tutor)
as the 'Educational Supervisor' of those in BST. They are responsible for
the formal appraisal of, and for ensuring the induction and formal assessment
of, trainees on BST and HST placements within their units.
Full details of the organisation of postgraduate training in ophthalmology
may be found in the Guide to Postgraduate Training in Ophthalmology (please
see Appendix III).
Examination Structure of the Royal College of Ophthalmologists
Under new rules adopted in 1998, the Royal College of Ophthalmologists
no longer requires candidates for its examinations to have worked in approved
training units. Candidates must have completed the requisite period of
training in any ophthalmic unit in order to be eligible to sit the examinations.
This change should make it much easier for overseas trainees to take the
examinations without the need to have worked in the United Kingdom, but
overseas candidates must still be eligible for registration with the GMC
of the UK. Please note however, that for those trainees wishing to obtain
a Certificate of Eligibility for Entry into Higher Specialist Training
(CEEHST), a minimum of two years BST must take place in College approved
Basic Specialist Training posts.
The Membership (MRCOphth) examination has replaced the old-style Fellowship
(FRCOphth). It consists of three parts:
Part 1, which consists of 2 multiple choice question (MCQ) papers
and one short answer paper. The subject material covers basic science in
relation to ophthalmology and includes anatomy, physiology, pathology,
immunology, microbiology and statistics. Part 1 can be taken at any time
once the pre-registration year (or equivalent) is completed.
Part 2 or Clinical Methods, which explores a candidate's ability
to conduct the necessary examinations required to assess a patient including
refraction. The MCQ paper also tests theoretical knowledge in optics and
refraction. There is a practical refraction examination and two objectively
structured examinations, one clinical and one object-based. Part 2 can
be taken after twelve months of full-time ophthalmic training.
Part 3, which is a clinical examination. From September 2003
there will be a new examination structure for the Part 3 MRCOphth. The
examination will consist of an extended matching question paper, a pathology
and microbiology structured oral examination, and a clinical multi-station
examination. The examination syllabus and entry requirements will remain
the same for the present time.
The new-style FRCOphth or Fellowship Assessment is taken by those in
Type I training towards the end of HST (i.e. after three years of HST)
once core curriculum has been completed. It consists of a written casebook
of ten chapters including case reports and an audit, plus an interview
of up to two hours duration.
Other UK Colleges
Full details of the College exams are available from the Examinations Department
(please see appendix below).
The format of the MRCS(Ed) is similar to that of the MRCOphth. There
are two routes to the CCST, one via the Fellowship Assessment of the Royal
College of Ophthalmologists and the other through the Specialty Fellowship
Examination in Ophthalmology of the Royal College of Surgeons of Edinburgh.
Candidates wishing to take the Edinburgh examinations should contact that
College for full details. These are the only two qualifications that are
recognised for entry into HST leading to the CCST. The Royal College of
Physicians and Surgeons of Glasgow and the Royal College of Surgeons of
Ireland also offer Fellowship examinations in ophthalmology that are not
recognised towards entry into HST and the details regarding eligibility,
syllabus and structure of the examinations can be obtained by writing to
these respective Colleges. Since 1999, the FRSGlas and the FRCSI are no
longer recognised for entry into HST and will not provide a route to the
CCST, but may be accepted by the General Medical Council for limited registration.
The Royal College of Ophthalmologists
17 Cornwall Terrace
NW I 4QW
Enquiries about the Dual Sponsorship Scheme and training should be addressed
The Deputy Head of Education and Training (at the above address)
Tel: 00 44 (0)20 7935 0702 Ext. 207
Fax: 00 44 (0)20 7935 9838
Enquiries about the College exams should be addressed to:
The Examinations Assistant (at the above address)
Tel: 00 44 (0)207935 0702 Ext. 212
Fax: 00 44 (0)20 7487 4674
Enquiries about the Ophthalmic Trainees Group (OTG) should be addressed
The OTG Co-ordinator (at the above address)
Tel: 00 44 (0 )20 7935 0702 Ext. 207
Fax: 00 44 (0 )20 7935 9838
Other useful addresses
General Medical Council
178 - 202 Great Portland Street
Tel: 00 44 (0)20 79153630
Immigration and Nationality Directorate
4 Wellesley Road
Croydon, CR9 2PY
Tel: 00 44 (0)8706 067766
The British Council
10 Spring Gardens
The British Council
58 Whitworth Street
Manchester M1 6BB
Tel: 00 44 (0)20 7930 8466
Tel: 00 44 (0)161 957 7000
British Medical Association
Tel: 00 44 (0)20 7387 4499
Overseas Doctors Association
316A Buxton Road
Stockport SK2 7DD
Tel: 00 44 (0)161 456 7828
Medical Defence Union
3 Devonshire Place
London W1N 2EA
Medical Defence Union
192 Altrincham Road
Manchester M22 4RZ
Medical Protection Society
33 Cavendish Square
London W1M 0PJ
Tel: 00 44 (0)20 7399 1300
Fax: 00 44 (0)20 7399 1301
Medical Protection Society
Granary Wharf House
Leeds LS11 5PY
Tel: 00 44 (0)113 243 6436
Fax: 00 44 (0)113 241 0500