Ameerah Ilyas
Ophthalmology requires long term dedication and passion for the specialty and this is reflected in the competition ratios in entering the specialty with recent competition ratios in 2025 being 21.5:1 with 2,197 applications for 102 posts (1). The competitive nature of the specialty is displayed through the application process including the portfolio requirements. The breadth of domains to cover include previous posts and experience, quality improvement audit, research and teaching with extra points awarded to awards/prizes dedicated at an undergraduate level (2). The limited exposure to the specialty during foundation years in addition to medical school years can make it difficult to obtain the vital points to enhance your portfolio, hence the desirability of posts such as the Clinical Teaching Fellow (CTF) posts (3). This article will explore the benefits of the post and how it improves the chances of obtaining a training number in ophthalmology.
Role of a Clinical Teaching fellow in Ophthalmology
Clinical teaching fellows are posts taken after FY2 and few are focused on ophthalmology. They serve as a pathway to obtain vital exposure to the field, getting involved in research and ultimately understanding more of what the career entails prior to entering specialty training.
The role of the clinical teaching fellow post is to provide teaching to undergraduate medical students, research and clinical experience. The majority of the role is centred around creating teaching sessions on common ophthalmological presentations covered under the curriculum. This can include acute ophthalmic emergencies, keratitis, as well as differentials for the red eye. This is supported by clinical examination sessions including the basics of a slit lamp, assessing for RAPD, visual acuity testing as well as relevant further appropriate clinical tests.
The clinical aspects of the post can vary and involve participation in clinics whereby you will be expected to carry out a thorough history and examination as well as interpretation of relevant tests to the standard of an ST1 trainee. These can range from oculoplastic clinics where you will be expected to do procedures such as lacrimal syringing, botox injections and listing for surgeries such as dacryocystorhinostomy. You will then be expected to formulate a plan with recommended follow up, which you will discuss with your supervising consultant and convey to the patient. Each clinic provides a basis for developing key examination and interpretation of diagnostic tests relevant to the specialty. The average week is summarised in Table 1 with on-call commitments based on a shared timetable with the other senior house officers.
Table 1 Summary of a week as a Clinical Teaching Fellow
| Morning | Afternoon | |
| Monday | Teaching session | Emergency eye department |
| Tuesday | Emergency Eye Department | Ocuplastics Clinic |
| Wednesday | Medical Retina Clinic | Emergency Eye Department |
| Thursday | Emergency Eye department | Glaucoma Clinic |
| Friday | Emergency eye department | Cornea Clinic |
| Saturday/Sunday | On call commitments |
Advantages of the role
The role provides a key basis for obtaining points required for the specialist training programme in a structured manner whereby you are also able to develop skills required for when you potentially start training. These can include examination techniques and the interpretation of basic tests relevant to the subspecialty. During your allocated time in the emergency eye department, you are exposed to a variety of different conditions and through the support of the senior members it provides a key learning opportunity to develop your understanding and management on a wide variety of acute ocular conditions. Being supported by experienced and approachable senior clinicians, it creates a learning environment which encourages growth and provides an enjoyable experience despite the steep learning curve.
In addition, many roles provide supported time for your PGCert in Medical Education which will also provide additional points and enhance your portfolio. It will also be supported by your regular teaching sessions to undergraduate medical students and formal examination roles.
The post also provided many opportunities for audits, involvement in research projects and participation in conferences. In comparison to conventional training posts, the role allowed the time and flexibility to be involved in research projects that would otherwise be difficult to complete when involved in a role with demands of frequent on-call shifts. These academic achievements do not only strengthen your portfolio, they also develop your understanding of and exposure to a variety of ophthalmic conditions.
Drawbacks of the role
There are many advantages of the post but also some drawbacks in comparison to a conventional training post. The main being the surgical exposure, ophthalmology involves a considerable amount of time perfecting surgical techniques and while the teaching fellow post allows academic progression it is limited in terms of surgical exposure. The demand of theatre time being allocated to trainees means there is limited to no surgical exposure which should also be an important consideration.
The balance of teaching responsibilities in addition to clinical involvement and development of your portfolio can be demanding. The considerable amount of time that is involved in curating teaching sessions in order for them to be engaging and interactive is often overlooked within the timetable. This can mean a lot of preparation work is expected during your free time. There is also a constant development of teaching sessions, when creating effective teaching sessions it is important to incorporate feedback from previous sessions to enhance and provide consistent high standards of teaching.
Conclusions
Overall, the experience of becoming a teaching fellow was extremely rewarding and developed my role as a clinician and also as an educator. It provided me with exposure to the field that not only enhanced my portfolio but provided an invaluable perspective on what the benefits and challenges involved with pursuing a career in ophthalmology involves. The experience provided me with the insight that being a proficient doctor involved more than solely clinical knowledge, it also requires leadership, mentorship and communication.
The role allows time to develop professionally and while there are some potential drawbacks of the post I found it overwhelmingly positive to have exposure to the field prior to entering specialty training, more than you are able to grasp through taster weeks and short durations during your foundation years.
References
- NHS England | Workforce, training and education | Medical Hub. (2025). 2025 Competition ratios | Workforce, training and education | NHS England. (online) Available at: https://medical.hee.nhs.uk/medical-training-recruitment/medical-specialty-training/competition-ratios/2025-competition-ratios
- Severndeanery.nhs.uk. (2025). Evidence Folder – Severn PGME. (online) Available at: https://www.severndeanery.nhs.uk/recruitment/vacancies/show/oph-st1-26/evidence-folder-lib.
- Crabtree L. Comment on: ‘Is undergraduate ophthalmology teaching in the United Kingdom still fit for purpose?’. Eye (Lond). 2022 Nov;36(11):2216. doi: 10.1038/s41433-022-01976-w. Epub 2022 Feb 16. PMID: 35173271; PMCID: PMC8852967.