Shi Ian Soh, Shi Sean Soh

Ophthalmology ST1 remains one of the most competitive entry-level programmes in the UK. In 2025 there were 2,197 applications for 102 posts, a competition ratio of 21.54 compared with 14.41 in 2024 (1). Specialty-level figures for 2026 have not yet been published. The Medical Training (Prioritisation) Act came into force in March 2026. NHS England reports that overall competition ratios have halved and that prioritised doctors filled 98% of posts (2). Prioritisation applies at both shortlisting and offer for 2027 entry (3).

A previous article in this journal described the 2026 evidence folder and the introduction of self-assessment (4). The eight scored domains and maximum of 47 points (50 with layout) are unchanged for 2027. NHS England has changed the selection process and the evidence accepted in several domains (5,6). This article summarises the 2027 criteria and these changes, with practical guidance for applicants. Applicants should check the NHS England Medical Hub before scoring themselves because guidance may be updated during the round (6).

What has changed in the process

• Shortlisting is by MSRA alone. In 2026 the MSRA and unverified self-score were combined. In 2027 the self-score acts as a threshold: candidates below 19 do not progress, and the top 350 by MSRA go forward to folder review (5,7). Two assessors then review these folders. The top 260 by verified score are invited to interview, while anyone scoring below 20 does not progress (7).
• Final ranking uses the verified evidence folder score and the virtual assessment, each worth up to 50 points. The MSRA does not contribute to the final rank (7).
• Applicants enter the same self-score on the proforma uploaded as the first document in the folder and on a separate MS Teams form. If either is missing, the application does not proceed. The score cannot be changed after submission (5,6).
• There are two Oriel adverts, one for England, Scotland and Northern Ireland and one for Wales. Applicants should use only one. If both applications are live at closing, the earlier one is withdrawn (5).
• Feedback and assessor comments are released on 25 February 2027. Applicants have 48 hours to appeal and can use only the evidence originally submitted. The appeal panel’s score is final, even if lower (5,8).
• From 2028, self-scoring moves to Oriel at application. Achievements completed after the November 2027 closing date will not count (5).

Table 1. Key dates for the 2027 round (8)

Stage	Date
Applications open	Thursday 22 October 2026, 10am
Applications close	Thursday 19 November 2026, 4pm
Self-assessment and evidence upload	Monday 18 January to Tuesday 2 February 2027
Self-assessment feedback	Thursday 25 February 2027
Invitations to interview	Monday 15 March 2027
Interview dates	Monday 22 and Tuesday 23 March 2027
Initial offers	Tuesday 6 April 2027, 5pm

How the evidence folder is scored in 2027

Table 2 summarises the 2027 criteria (6). It is a summary only; the full wording, the proforma and the list of contents for each domain are on the NHS England Medical Hub.

Table 2. 2027 scoring criteria at a glance (6)

Domain	Max	How points are earned
Qualifications	5	1 per qualification taken as a separate course of at least 8 months full-time or equivalent (MSc, BSc, PGCert; not intercalated). 3 for an MD or MPhil with at least 2 years’ additional research. 4 for a PhD or DPhil. MRCP and MRCS are not scored.
Prizes and awards	5	3 for the Crombie Medal. 2 for first place in the final year of a degree where fewer than 15% achieve this. National undergraduate exam prize (e.g. Duke-Elder): 3 first place, 2 top 10%, 1 top 20%; other national prizes need more than 400 entrants. 1 per lead-author research grant that led to peer-reviewed publication. 1 per best oral or poster as first author at a national or international meeting (max 2).
Multi-source feedback	2	2 for satisfactory scores with good comments. Within 18 months of interview; at least 7 respondents in a hospital post or 5 in general practice; signed and stamped unless a TAB printed from the e-portfolio.
QI and audit	5	Best project within 3 years, uploaded with a consultant letter confirming your role. 1 participation; 2 initiation and design; 3 plus write-up in a specific format; 4 plus personal involvement in implementing a QI strategy with demonstrated improvement, or in closing the audit loop and implementing change; 5 published in a peer-reviewed journal or implemented supra-regionally with evidence of impact. Max 1 if not clearly the lead.
Presentations	6	Oral: 1 regional, 2 national, 3 international. Posters and videos score half. Second or lower author: half the oral value only if you delivered it; nothing for posters or videos. Original work only; the same work counts once; accepted but not yet presented counts. Local hospital and university meetings are not scored.
Publications	6	Peer-reviewed original research or systematic reviews in a journal with a current Clarivate Journal Impact Factor. 3 first or joint-first author (three or more joint-first authors count as second); 1 second to fourth author (first author only if more than 8 authors); 0 fifth or lower. Case reports and letters go in specialty links.
Education and teaching	5	0.5 each (max 2) for helping on a course or mock OSCE, designing an e-learning tool, writing an e-book, a teaching-the-teachers course, or examining undergraduates. 1 for at least three formal (not ward-based) teaching sessions on different subjects over 3 months, with feedback and a supervisor letter. 2 for a higher teaching qualification (60 credits or 8 months). 2 for a chapter in, or 3 for authoring, a postgraduate academic book.
Specialty links and commitment	13	Refraction Certificate 1. FRCOphth Part 1: 3 pass, 1 attempt. RCOphth Foundation essay prize first place 1. Ophthalmology publications not used elsewhere (first author): 0.5 non-peer-reviewed, case report or letter; 1 peer-reviewed; max 2. Elective of at least 2 weeks or undergraduate project: 1 each, max 2, with reflection. Taster week 1. At least 10 clinic or theatre sessions over more than 3 months: 1. Simulation including EyeSi: 1 per activity of at least 4 hours, max 2. Meetings: 1 per national or international, 0.5 per regional (max 1), max 3 overall. Discretionary evidence 1 each, max 2.
Overall layout and quality	3	Presentation and organisation of the folder.

What has changed in the scoring criteria

Table 3 lists the domains whose criteria have changed since 2026 (4,6). Maximum scores are unchanged in every domain. Qualifications, multi-source feedback, education and teaching, and overall layout are unchanged.

Table 3. Domains that have changed between 2026 and 2027 (4,6)

Domain	Max	Change for 2027
Prizes and awards	5	The 2-point undergraduate prize now requires first place in the final year of the degree. In 2026, first place in any year was accepted.
QI and audit	5	The 4-point tier now asks for a specific demonstration of improvement to practice when a QI strategy is implemented. The 5-point supra-regional route now needs clear evidence of impact. A supervisor’s letter stating that improvements were made is not enough for 4 or 5 points; data must be uploaded.
Presentations	6	An abstract only scores if it links to a full article that can be reviewed. Co-delivered presentations must be declared, with the candidate’s equal role in preparation made clear. The rule that second or lower authors do not score for posters now also covers videos.
Publications	6	The journal must now hold a current Clarivate Journal Impact Factor. Together with the standing rule that peer-reviewed work must be PubMed-cited, both are needed to score.
Specialty links and commitment	13	Electives must be at least 2 weeks long. Peer-reviewed ophthalmology publications claimed here must now also be in a Clarivate-listed journal (PubMed citation was already required). Projects that led to a presentation or publication cannot also be scored in those domains.

Prizes and awards

For 2027, first- and second-year undergraduate prizes no longer score in this domain. The 2 points are awarded only for first place in the final year, where fewer than 15% of the cohort achieved it (6).

QI and audit

The 1- to 5-point scale is unchanged. Claims for 4 or 5 points now need the re-audit or outcome figures showing the change as well as the consultant’s letter. The letter confirms the applicant’s role, and the maximum is 1 point if they are not clearly the lead (6). The Clarivate impact factor rule does not apply in this domain, but peer-reviewed work still needs a PubMed citation (6).

Presentations

The evidence should include the full abstract and, where available, the associated paper rather than only the acceptance email. For a co-delivered presentation, state the candidate’s equal role in preparing it (6).

Publications

For a paper to score here, its journal must appear in Clarivate Journal Citation Reports and the PubMed ID must be entered on the proforma. If a first-author ophthalmology paper does not meet both conditions, it may instead score 0.5 points in specialty links as a non-peer-reviewed publication (6).

Specialty links

Electives now need to be at least 2 weeks. If a project led to a presentation or publication, it is scored there and not again in specialty links. The 2026 caution on online meetings remains: they may not score without enough detail on scope and reflective learning (4,6).

Practical points

• Check your score early. NHS England advises applicants with fewer than 19 points to consider applying in a later round (7).
• After the 19-point self-score threshold, shortlisting is based on the MSRA. The portfolio does not contribute further at this stage (5).
• For audit and QI claims worth 4 or 5 points, include the supporting data with the letter (6).
• Record the PubMed ID and impact factor status for each publication before the portal opens (6).
• Use each piece of work in one domain only. Unnecessary material may lose marks, and over-claiming is treated as a probity matter (6).
• Both score submissions must be completed. Feedback is released on 25 February 2027, with 48 hours to appeal (5,6,8).

Conclusion

The 2027 evidence folder remains similar to 2026, but some of the evidence needed has changed. The MSRA determines who reaches folder review, after which verified folder scores determine who is invited to interview. For the higher scores in QI, presentations and publications, the evidence now includes items such as outcome data, full articles, PubMed references and impact factor status. Knowing these requirements in advance should make it easier for applicants to score their evidence accurately and plan their preparation.

References

1. NHS England. Competition ratios [Internet]. London: NHS England; 2025 [updated 2025 Jul 24; cited 2026 Sep 27]. Available from: https://medical.hee.nhs.uk/medical-training-recruitment/medical-specialty-training/competition-ratios
2. NHS England. Impact of Medical Training Prioritisation Act on specialty training recruitment [Internet]. London: NHS England; 2026 Jun [cited 2026 Sep 27]. Available from: https://www.england.nhs.uk/2026/06/impact-of-medical-training-prioritisation-act-on-specialty-training-recruitment/
3. NHS England. Medical Training (Prioritisation) Bill: information for applicants to medical training [Internet]. London: NHS England; 2026 [cited 2026 Sep 27]. Available from: https://www.england.nhs.uk/long-read/medical-training-prioritisation-bill-information-for-applicants-to-medical-training/
4. Jafari M. Ophthalmology ST1 2026 portfolio: evidence folder updates and practical guidance. Journal of the Foundations of Ophthalmology [Internet]. 2025 Oct 11 [cited 2026 Sep 27]. Available from: https://www.jfophth.com/ophthalmology-st1-2026-portfolio-evidence-folder-updates-and-practical-guidance/ doi:10.48089/jfo7688320
5. NHS England. Ophthalmology ST1: selection process [Internet]. London: NHS England; 2026 [updated 2026 Sep 25; cited 2026 Sep 27]. Available from: https://medical.hee.nhs.uk/medical-training-recruitment/medical-specialty-training/ophthalmology/ophthalmology-st1/overview-of-ophthalmology-st1/selection-process
6. NHS England. Ophthalmology ST1: self assessment and supporting evidence [Internet]. London: NHS England; 2026 [updated 2026 Sep 23; cited 2026 Sep 27]. Available from: https://medical.hee.nhs.uk/medical-training-recruitment/medical-specialty-training/ophthalmology/ophthalmology-st1/overview-of-ophthalmology-st1/self-assessment-and-supporting-evidence
7. NHS England. Ophthalmology ST1: scoring, ranking and offers [Internet]. London: NHS England; 2026 [updated 2026 Aug 27; cited 2026 Sep 27]. Available from: https://medical.hee.nhs.uk/medical-training-recruitment/medical-specialty-training/ophthalmology/ophthalmology-st1/overview-of-ophthalmology-st1/scoring-ranking-and-offers
8. NHS England. Ophthalmology ST1: recruitment timelines [Internet]. London: NHS England; 2026 [updated 2026 Sep 1; cited 2026 Sep 27]. Available from: https://medical.hee.nhs.uk/medical-training-recruitment/medical-specialty-training/ophthalmology/ophthalmology-st1/overview-of-ophthalmology-st1/recruitment-timelines