How to Approach the Refraction Certificate Examination for FRCOphth

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How It Fits into the FRCOphth Timeline

The Refraction Certificate is a mandatory component of the Fellowship of the Royal College of Ophthalmologists (FRCOphth) pathway. It is designed to ensure that ophthalmology trainees and candidates demonstrate safe and competent clinical refraction skills before completing their final examinations.

This exam is often misunderstood or underestimated — yet it is an essential hurdle that must be cleared before attempting the FRCOphth Part 2 Oral examinations.

Where Does It Fit in the FRCOphth Pathway?

The FRCOphth pathway typically follows this sequence:

  1. FRCOphth Part 1 – Basic sciences, no clinical experience required
  2. Refraction Certificate – Practical exam in retinoscopy and subjective refraction
  3. FRCOphth Part 2 Written – Clinical ophthalmology and patient management
  4. FRCOphth Part 2 Oral (Viva + OSCE) – Final stage of assessment

To sit for the FRCOphth Part 2 Oral, candidates must first have passed both the Part 2 Written exam and the Refraction Certificate.
Importantly, candidates must also have passed FRCOphth Part 1 to be eligible to apply for the Refraction Certificate. This makes the Refraction exam not just a skill checkpoint, but a critical milestone within the FRCOphth journey.

Booking, Exam Content, and Preparation

The Refraction Certificate is a practical exam testing your skills in objective and subjective refraction using retinoscopy and other manual techniques.

Booking and Availability

  • Offered: 3 times annually (usually March, July, November)
  • Application Window: Opens ~12 weeks before the exam date
  • Exam Centres: Primarily held at RCOphth’s designated testing sites in the UK
  • Booking Platform: RCOphth Examinations Page

Due to limited slots and hands-on testing logistics, this exam can fill up quickly. Candidates are advised to check booking windows regularly and register early.

Exam Format and Duration

The exam typically runs for 90–120 minutes, depending on the number of stations and candidates per batch. It includes:

1. Objective Refraction

  • Retinoscopy at various working distances
  • Cylinder axis estimation
  • Sphere and cylinder power estimation

2. Subjective Refraction

  • Fogging techniques
  • Jackson cross cylinder (JCC)
  • Determining best corrected visual acuity (BCVA)

3. Clinical Judgement and Accuracy

  • Final prescription formulation
  • Documentation and communication of refraction findings

Key Elements:

  • Each station is timed, usually around 10 minutes
  • Real or model eyes are used in some stations
  • Examiners assess accuracy, methodology, communication, and safety

Full guidance is available on the official Refraction Certificate syllabus published by the Royal College of Ophthalmologists.

Preparation Strategy

Unlike written exams that rely heavily on textbook knowledge, the Refraction Certificate focuses on applied skills. Hence, the preparation style must reflect this practical orientation.

Here is a structured preparation strategy to guide your journey:

Week 1–2: Understand the Syllabus

  • Study the Refraction Certificate syllabus from RCOphth
  • Watch official RCOphth videos (if available)
  • Read chapters from:
    • Clinical Optics by Elkington
    • Optics Made Easy for FRCOphth candidates
  • Familiarise yourself with:
    • Retinoscopy theory (spherical and cylindrical)
    • Visual acuity measurement standards
    • Subjective refraction techniques

Week 3–5: Hands-On Practice

  • Practice daily using retinoscopes and trial lenses
  • Partner with colleagues to simulate exams
  • Time yourself for each step: reflex detection, JCC use, finalisation

Week 6–7: Mock Scenarios and Simulation

  • Complete full-length mock exams in real conditions
  • Get feedback on technique, timing, and prescription accuracy
  • Focus on consistency and confidence under exam conditions

Daily Micro-Practice

  • 15 minutes of reflex movement identification
  • Trial lens ordering and communication script
  • Error spotting (e.g. over-minusing or axis misjudgement)

For many international doctors or early trainees, mastering retinoscopy and subjective refraction without daily clinic access can be a challenge. This is where focused mentorship and structured simulation can be a game-changer.

PrepMedico offers:

  • Personalised guidance from FRCOphth-qualified mentors
  • One-on-one technical drills for retinoscopy and JCC
  • Mock station walkthroughs with exam-style timing
  • Structured feedback on lens choice, communication, and workflow

This kind of targeted training ensures that candidates don’t just memorise techniques, but build real confidence with real cases or simulated patient models. This approach also fits especially well for those preparing while working full-time or outside UK teaching hospitals.

You can explore our offerings here: PrepMedico FRCOphth Support

For full exam details, booking updates, and resources, explore: RCOphth Refraction Certificate Exam Page

You must hold a medical degree recognised by the GMC or equivalent authority. For Part 2 Written, candidates must have completed a minimum of 36 months of clinical ophthalmology training, including surgical and diagnostic experience, aligned with the RCOphth curriculum.

Applications open 10–14 weeks before the exam date, depending on the part. Results are usually released within 4–8 weeks after the exam. Early planning is key.

For Part 1:

  • Valid ID
  • Medical degree certificate

For Part 2:

  • All of the above
  • FRCOphth Part 1 certificate
  • Training logbook
  • Consultant reference (especially if outside the UK)

As per the latest RCOphth exam fee schedule, approximate costs for the UK region are:

  • Part 1: ~£695
  • Part 2 Written: ~£695
  • Part 2 Oral (viva & OSCE): ~£1150

Note: These fees apply to exam sittings in the UK only. If you are taking the exam in an authorised international centre, costs may vary depending on the location and local arrangements.

Fees are subject to change. Check the official site for the most up-to-date information.

Yes. PrepMedico provides application guidance as part of the mentorship model. This includes reviewing your eligibility, assisting with document preparation, and ensuring timelines are met, without making the process overly commercial.

RCOphth offers overseas exam centres for Part 1 and Part 2 Written in locations such as India, UAE, Malaysia, and Singapore.

Part 2 Oral (Viva + OSCE) is primarily conducted in the UK, but may be held internationally in certain regions (e.g. India, Egypt, UAE) depending on demand.

You are allowed up to 6 attempts for Part 1 and 4 attempts each for Part 2, Written and Oral. Attempts made before August 2013 (Part 1) or August 2014 (Part 2) are not counted.