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8
Final tips for the exam
More than 2 months before the exam
Read this book!
Read the Refraction Certificate Examination application details very carefully and contact the Royal College if you have any uncertainties about what is expected of you.
Consider attending a course on refraction. This will no doubt be helpful, but they are expensive and absolutely no substitute for refracting yourself.
Get study leave – not just for the exam but for the week before the exam, during which time you must refract intensively.
Get refracting! Print out Appendix 1, ‘Typical refractive recording sheet’, and fill in for each person you refract. Keep all these sheets so you can keep a record of how many you have done and what you have learnt from each one.
Ideally, get your own retinoscope and borrow a decent trial frame and JCCs so that you are familiar with the equipment that you will use in the examination.
One month before the exam
By now, you will probably have realised that the main limitation to practising is obtaining a free room and a subject to refract. It does not take long to refract everybody in the department, so you will need to look elsewhere.
Try all staff – this includes medical, nursing, health care assistants, students and administrative staff. Another option is to refract patients whilst they are waiting to be seen during clinic.
Aim to refract patients of all ages (children, pre-presbyopic adults, presbyopic adults) and with different characteristics (high myopia, high hypermetropia or aphakia, those with significant astigmatism, those that need prismatic control, small pupils, clear phakic lenses, those with cataract and pseudophakic patients).
Remember to practice both non-cycloplegic and cycloplegic refraction.
Finally, consider booking people in advance into 30-minute slots to refract during your study week to ensure a final burst of resources!
One week before the exam
Concentrate on getting your numbers up by refracting the people that you have booked into your free study week.
Re-confirm that you understand the examination format.
Check you have all the things you will need for the examination:
- your own retinoscope (place fresh batteries in this and take a spare pair)
- a borrowed trial frame and JCCs
- an occluder, rule and pen torch (for the cover test)
- your passport or driving licence (required by examiners to confirm your identity)
- all the examination, accommodation and travel details
On the day
Prepare for starting with any station first.
Remember to be consistent when recording your results – always use only positive cyls or only negative cyls (do not use both positive and negative cyl nomenclature). Always specify the working distance and correct for this.
All dioptric powers should be to two decimal places and have a clear + or – sign (e.g. +0.25, –1.50). The degree symbol (°) should be avoided and all axes should be to three significant figures (e.g. 045, 010, 135).
Keep your lenses tidy – it will annoy the examiners if they have to tidy up after you.
If you find yourself struggling with a retinoscopy reflex, do not just sit there persisting, as prolonged retinoscopy sweeping is uncomfortable for the patient, induces accommodation and demonstrates to the examiners your uncertainty. No retinoscopy sweep burst should take longer than a few seconds, so try to make a decision and simply come away and try a different lens if you are unsure.
Before formally starting, check that you are comfortable with the room set-up (lighting, record sheet and equipment) then ask questions if you are uncertain before the bell actually goes.
Good luck!
Jonathan C Park and David H Jones
