Candidate reference number : __________________

Signed : ____________________________________________________________ Date : _____________________________

Name (please print) : _______________________________________________________

To the applicant : this shows the scoring system to be used for short-listing from the application form. If the short-listing panel agrees that you have scored “0” in any of the essential criteria this means that you have not provided sufficient evidence to demonstrate the attribute. You therefore cannot be shortlisted. You are advised to self-assess yourself prior to application and to seek advice from your educational supervisor if necessary. This should not be returned with your application. It is for your information only.

THE LONDON DEANERY in association with the East of England and Kent, Surrey & Sussex (KSS) Deaneries

SHORT-LISTING SCORE SHEET – SPECIALTY TRAINING IN OPHTHALMOLOGY – ST 1 – 2011

ENTRY CRITERIA Assessed In Section YES/NO ESSENTIAL CRITERIA

Eligible for registration with the GMC and holding a current license to practice

Eligibility to apply To be confirmed at interview

Has this applicant scored a 0 in any of the essential criteria?

YES / NO

MBBS (or equivalent) Professional Qualifications

18 months or less experience in this specialty (not including Foundation modules ) by August 2010

Employment History & Competences

Evidence of current employment in a UKFPO affiliated Foundation Programme

OR

12 months experience after full GMC registration or equivalent and evidence of achievement of Foundation competences between 31st July 2008 and 3rd August 2011 from a UKFPO affiliated Foundation Programme or equivalent by time of appointment

Competences

ESSENTIAL CRITERIA MaxScore Score Assessed in this Section of the

Application Form DESIRABLE CRITERIA Max Score Score

Professional Qualifications & Employment History & Experience &

Commitment (1)

Additional undergraduate qualifications, degrees and distinctions eg intercalated BSc, BA BMedSci or equivalent and/or postgraduate qualifications eg PhD, MRCP, FRCOphth part 1

6

Candidate reference number : __________________

Signed : ____________________________________________________________ Date : _____________________________

Name (please print) : _______________________________________________________

ESSENTIAL CRITERIA MaxScore Score Assessed in this Section of the Application Form

DESIRABLE CRITERIA Max Score Score

Clinical Knowledge and Experience 2 Experience and Commitment (1,2)

Experience and Commitment (2) Attendance at relevant course (s) eg Microsurgical skills course etc

2

Appropriate career progression 2 Experience and Commitment (1,2,3) Extra curricular activities / achievements relevant to ophthalmology

2

Audit and Management (1) Evidence of active participation in audit

2

Demonstrates an understanding of the principles of research

2 Academic Achievement (1,2,4,5,6) Research experience, presentations, publications, prizes and honours

4

Academic Achievements (1,3) Evidence of interest and experience in teaching

2

Total number of points (Maximum - 24) Points scored ______________________

Minimum number of points required to be considered for short-listing is 13

Minimum number of points required to be considered for short-listing is 10

Please note that if an applicant achieves this score he/she will not automatically be short-listed. This is the minimum standard which must be achieved, but the final shortlist for interview will also reflect the ranking of applicants applying on this occasion.

Any attributes which are evaluated on the basis of the application form alone may be further explored at the interview stage