Ophthalmology ST1 (OST) Application Guide (2027 Entry)

Introduction

This guide is for the 2027 recruitment round for Ophthalmic Specialty Training (OST), a programme that takes a minimum of seven years, according to NHS Health Careers, and leads to a Certificate of Completion of Training (CCT) and eligibility to become a Consultant Ophthalmologist. NHS England recorded 1,141 applications for 115 posts in 2026, a competition ratio of 9.92 to 1, down from 21.54 to 1 in 2025. This may appear daunting, but understanding the selection criteria and preparing early are essential to a successful Ophthalmology ST1 application.

NHS England (South West) coordinates the national selection process through the Ophthalmology National Recruitment Office, so check the NHS England Medical Hub Ophthalmology ST1 pages regularly for updates on the evidence folder and the timeline. For 2027 there are three stages: the multi-specialty recruitment assessment (MSRA), which alone decides shortlisting; the evidence folder with a self-assessment score; and a virtual assessment made up of two role plays. The verified self-assessment score is carried into your final total score.

What can Medset do to help?

Medset’s Ophthalmology ST1 Interview Course is an online course created by Dr May Wong, an ophthalmology specialty registrar, that covers the interview format, common consultations and practice stations.

What Is New for 2027

• Shortlisting is the MSRA alone. Last year the MSRA and the unverified self-assessment were combined. From 2027 your MSRA score alone decides who is put forward to the evidence stage.
• Two Oriel adverts. One is for England, Scotland and Northern Ireland and one is for Wales. You can apply to only one. If you apply to both, the earlier application is withdrawn at close.
• Five applications. NHS England says applicants can submit a maximum of five applications per recruitment round in 2027.
• Prioritisation. The Medical Training (Prioritisation) Act 2026 applies at the offer of an interview and the offer of a place. For ST1 recruitment, the relevant qualifying UK programme is the UK Foundation Programme only. Read the criteria on the NHS England prioritisation page.
• Looking ahead. From the 2028 round you will self-score on Oriel at the time of application. This does not apply to the current round.

The MSRA Examination

The Multi-Specialty Recruitment Assessment (MSRA) is a computer-based assessment lasting 170 minutes, in two papers: Professional Dilemmas (95 minutes), a situational judgement test, and Clinical Problem Solving (75 minutes). Attendance is mandatory, and scores from previous years cannot be carried forward. If you have sat the Situational Judgement Test (SJT) for the Foundation Programme, the Professional Dilemmas questions will feel familiar. They assess key attributes from the GMC’s Good Medical Practice, including patient focus, professionalism, coping with pressure, communication and teamwork. If your primary medical qualification is from outside the UK, many candidates find the NICE Clinical Knowledge Summaries a useful guide to UK primary care practice. There are multiple online question banks for both papers.

Application Timeline (2026–2027)

Being aware of deadlines is crucial, as missing any date can disqualify you. Below is the official timeline for this cycle from NHS England:

Top Tips For The MSRA

Start practising early with question banks! The breadth of the curriculum may initially seem overwhelming, but you can use the questions to guide your revision and identify key areas that require more work. A common approach is to start revision 2 to 3 months before the examination; you may need to alter this depending on your other commitments and work schedule. If you are applying from outside the UK, you may need more time to familiarise yourself with UK guidelines.

Watch Oriel after applications close. You will receive a message asking you to register with Pearson Professional Examinations using the credentials in that message. Register once, even if you applied to several specialties, and keep your username safe. The invitation to book follows in early December, and some centres have limited availability, so book your slot as soon as you can.

Use the official MSRA practice paper. The MSRA team publishes a practice paper with an answer key and rationales, which is particularly useful for the Professional Dilemmas paper because it shows what the examiners are looking for.

The Evidence Folder

You score yourself across eight domains, with a maximum of 47 points, and submit evidence to support your scores. You need to score at least 19 points to continue, whatever your MSRA score. The evidence folders of the 350 candidates put forward on MSRA score are reviewed by a panel. If your verified score is below 20 points you do not progress to the next stage. Feedback is released on 25 February 2027. You then have 48 hours to appeal, and the appeals panel’s score is final even if it is lower. You cannot upload new documents on appeal.

The domains and their maximum points are: qualifications (5), prizes and awards (5), multi-source feedback (2), quality improvement and audit (5), presentations (6), publications (6), education and teaching (5), and ophthalmology specialty links and commitment to date as a career (13). A further 3 points are available for the overall layout and quality of your portfolio.

The scoring criteria are highly prescriptive, and you should use them to guide your evidence. Don’t worry if your portfolio is not geared towards ophthalmology: peer-reviewed publications and presentations in other fields still count, though the same work cannot be used in more than one domain.

Top Tips For Portfolio

Format your folder according to the published list of contents. You can score 3 points just for the layout and quality of your portfolio. For context, passing FRCOphth Part 1 also scores 3 points. Marks may be deducted for including unnecessary information, and the self-assessment pro forma should be the first document in your folder. You must also submit your scores through a form, and the score cannot be changed once submitted. Include no patient-identifiable information. If you are including a letter as evidence, try to quote the exact wording that supports the score.

Aim to score full marks in the “Ophthalmology specialty links and commitment to date as a career” domain. It is worth 13 of the 50 points available. Ways to score include attending ophthalmology educational meetings (1 point per national or international meeting, and 0.5 points per regional meeting up to 1 point in total), a taster week (1 point) and ophthalmology simulation training (1 point per activity of at least four hours, up to 2 points).

Attend relevant courses. In the “Education and Teaching” domain, completing a “teaching the teachers” course can earn 0.5 points, and items of this kind are capped at 2 points in total. The cap is shared with helping on an educational course or mock OSCEs, designing an e-learning tool, writing an e-book and a formal role in examining undergraduates. Medset’s Train the Trainers course is a teaching-the-teachers course, available online (self-paced) or as a live virtual classroom, and carries 12 CPD points. NHS England does not set a minimum length or format for this item and asks for evidence such as an attendance certificate. There is no leadership domain in the 2027 evidence folder, so a leadership and management course does not score.

The Interview

The assessment is made up of two separate interviews (role plays) with an actor, each lasting up to 10 minutes, with 5 minutes of reading time before each. You can make notes in the reading time and take them in. One is a consultation focusing on clinical knowledge. The other is a consultation focusing on a difficult communication or ethical scenario. Two assessors observe and score each one, and you may start with either. The whole process, including identity checks and debrief, takes about 45 minutes. It takes place virtually on 22 and 23 March 2027, and you book a slot through Oriel on a first-come, first-served basis.

From the verified evidence-folder scores, the highest 260 applicants, and none with fewer than 20 points, are invited to the interview, and the rest are held on a reserve list. NHS England’s scoring, ranking and offers page says you need at least 40% in the assessment to progress to the offer stage. Your final rank then comes from the evidence folder (maximum 50 points) and the online assessment (maximum 50 points), so the two count equally, and the MSRA score is not included in the total.

Medset’s Ophthalmology ST1 Interview Course lists modules on the interview overview, format, focus and mark scheme, essential communication and interview skills, and common consultations such as apologising for an error, poor-prognosis diagnoses and cancelled surgery. It also has practice stations, for example on conjunctivitis, temporal arteritis, double vision and visual loss, and a section on common eye conditions.

Top Tips For The OST Interview

Start practising early! A common mistake is to leave practice until you have an invitation. Invitations go out on 15 March and the interviews are on 22 and 23 March, which leaves about a week to prepare. A good rule of thumb is to start around the time of your Oriel application (22 October to 19 November 2026), practising weekly or fortnightly, then increase the frequency towards the interview date.

Practise with different groups of people. By switching your practice buddies, you learn different communication techniques and approaches. It may feel uncomfortable to practise with people you are not familiar with, but this best mimics the actual scenario.

Record yourself (both on video and via transcript). Watching recordings can help you refine your consultation skills by picking up on body language such as eye contact and hand movements, and on how you phrase a diagnosis or plan. (Was it unclear? Too long? Too much jargon?) Use Teams if you have access to it via the NHS, as it is a good way to rehearse a virtual interview, and you can switch on the “Transcript” function to look back on what you say. Check your joining instructions for the platform used on the day, because NHS England has not named it.

Frequently Asked Questions

What MSRA score do I need for Ophthalmology ST1?

NHS England does not publish a required MSRA score for Ophthalmology. For 2027 the MSRA alone decides which 350 candidates have their evidence folder reviewed, so aim as high as you can.

Does my portfolio still matter if shortlisting is the MSRA alone?

Yes. You must self-score at least 19 points to continue, your verified score must reach 20 to progress, and the evidence folder is worth up to 50 of the 100 points in the final total.

Can international medical graduates apply?

Yes, but the Medical Training (Prioritisation) Act 2026 applies at the interview and offer stages, so check your priority status on the NHS England Medical Hub before you apply.

Summary

Getting into Ophthalmology ST1 training may initially seem daunting, but with early preparation based on the official sources, you will give yourself the best chance of excelling in your application. Ophthalmology is a fascinating and rewarding specialty (the author makes no apology for being biased about this!) and is well worth investing your time, energy and resources into securing a training position. Our OST Interview Course is one option for interview preparation, and we run other courses for doctors and health professionals here at Medset.