Candidate reference number : __________________ 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
Eligible for registration with the GMC and holding a current license to practice MBBS (or equivalent) 18 months or less experience in this specialty (not including Foundation modules ) by August 2010 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 rd July 2008 and 3 August 2011 from a UKFPO affiliated Foundation Programme or equivalent by time of appointment

Assessed In Section
Eligibility to apply Professional Qualifications Employment History & Competences Competences

YES/NO
To be confirmed at interview

ESSENTIAL CRITERIA
Has this applicant scored a 0 in any of the essential criteria? YES / NO

ESSENTIAL CRITERIA

MaxScore

Score

Assessed in this Section of the Application Form

Professional Qualifications & Employment History & Experience & Commitment (1)

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

Max Score
6

Score

Signed : ____________________________________________________________ Date : _____________________________ Name (please print) : _______________________________________________________

Candidate reference number : __________________ ESSENTIAL CRITERIA

Clinical Knowledge and Experience

MaxScore
2

Score

Assessed in this Section of the Application Form

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

DESIRABLE CRITERIA

Max Score

Score

Attendance at relevant course (s) eg Microsurgical skills course etc Extra curricular activities / achievements relevant to ophthalmology Evidence of active participation in audit Research experience, presentations, publications, prizes and honours Evidence of interest and experience in teaching

2 2

Appropriate career progression

Experience and Commitment (1,2,3)

Audit and Management (1) Demonstrates an understanding of the principles of research 2 Academic Achievement (1,2,4,5,6) Academic Achievements (1,3)

2 4 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

Signed : ____________________________________________________________ Date : _____________________________ Name (please print) : _______________________________________________________