All the information you need about the Common Final Assessment in Independent Prescribing from what the examination is based on to what to do when you pass. The purpose of the final examination is to ensure that you have the knowledge and skills to enter the specialist register in Independent Prescribing.
The results of the November 2020 Common Final Assessment in Independent Prescribing are available here.
The TCFA in Independent Prescribing takes place three times a year in March, June and November.
March 2021 Examination
Application, Logbook & payment deadline: 5 February 2021
Examination date: 4 March 2021
Results date: 23 March 2021
Content
The content of the examination will be drawn from the Clinical Management Guidelines. A combined Zip version of the CMG's for the latest examinaton (May 2020) can be downloaded by clicking the document below.
Questions relate to the application of clinical knowledge in terms of differential diagnosis, interpreting clinical signs, pharmacological and non-pharmacological management, monitoring, and prescribing safely and professionally (including risk assessment). One third of the examination questions will be related to glaucoma.
If you have a disability and require adjustments to the way the examination is administered, visit the Reasonable Adjustments section for more information.
The assessment will consist of a key features assessment consisting of 75 multiple choice questions + 10 pilot questions (single best answer or multiple answer), divided into patient centred scenarios of between 3 and 5 items. The examination will last 102 minutes and will be computer based.
Following revisions to the number of new questions included in the examination by the GOC, from November 2017, the following changes will be implemented:
All questions, including those that have been newly written for the examination, are scrutinised by members of the IP question development team, which consists of a mixture of IP-qualified optometrists and ophthalmologists. The examination is then checked and signed off by two external examiners, who are an experienced IP optometrist and a GOC-approved ophthalmologist. The final version of the paper is then signed off by the Chair of the Standards Setting Panel.
The examination is pass/fail and no grades will be awarded.
Sample questions, as well as screenshots of how questions will be displayed and develop in the examination software, are below. These are for demonstration purposes only and should not be used as revision materials.
You will be told the time of your assessment when we confirm your place. Please arrive at the centre in good time. If you are late, you may have to defer until the assessment is held again.
You will be required to bring a passport or photo card driving licence so that we can check your identity. If you do not have either of these documents, please contact us in advance so we can discuss how you might prove your identity in another way.
You must not falsify the evidence you provide in your portfolio by altering any paperwork or using the work of others in any other way. Nor must you permit others to copy or use your work. At the assessment, you will be provided with all the materials you need, except for the British National Formulary which you must bring with you. You must not use or refer to any other materials or try to communicate with other candidates during the assessment. All books, papers, mobile phones and other electronic equipment must be stored away when you begin. You must not take any examination materials out of the centre, you must not write down the details of the examinations to take out and you must not obtain information about the examination from any source including other candidates. To avoid contact between candidates, you may be asked to remain in the examination room for the full 90 minutes of the examination or to be isolated for a period before sitting the examination.
After the examination
Over time a variety of different methods have evolved for setting standards, all of which have advantages and disadvantages depending on the specific application. The Angoff method we use is an absolute method based on judgements about individual test questions (rather than about individual examinees). The Angoff method is relatively easy to use, there is a sizeable body of research to support it, and it is frequently applied in licensing and certifying settings.
A Standard Setting Panel made up of optometrist prescribers and ophthalmologists decide the probability that a ‘just good enough’ professional would answer each question correctly. The median is calculated for each question, so for a difficult question the probability might be 0.3 and for an easy question 0.8. The pass mark for the examination is calculated by adding the Angoff scores for each test item. Using the Angoff method means that the pass mark will change from assessment to assessment depending on the difficulty of the items. This allows for a more reliable assessment process, which is important for a high-stakes examination.
Angoff is about standard-setting but in addition, the Standard Setting Panel look at item performance after carrying out the Angoff methodology to pick up if there is anything statistically anomalous. The Panel also investigate any candidate feedback about items following the examination. This enhances the quality assurance process and this is why the pass mark is set after the examination. The Panel are not made aware of individual candidate performance at any stage of this process.
Results are released two weeks after the assessment.
College members will be able to access their result by logging in to the results section which will be highlighted above. A detailed breakdown of performance will also be sent by first class post.
Non-College members will receive their result and a detailed breakdown of performance by first class post.
If you pass, the section below details the next steps to registration. If you fail, you may resit the assessment when you are ready.
Previous pass rates
2019
| Sitting | No. of candidates | No. passes | Pass rate (%) |
|---|---|---|---|
| April 2019 | 55 | 42 | 76 |
| June 2019 | 54 | 51 | 94 |
| November 2019 | |||
| Total |
2018
| Sitting | No. of candidates | No. passes | Pass rate (%) |
|---|---|---|---|
| April 2018 | 38 | 27 | 71 |
| June 2018 | 50 | 45 | 90 |
| November 2018 | 81 | 69 | 85 |
| Total | 169 | 141 | 82 |
2017
| Sitting | No. of candidates | No. passes | Pass rate (%) |
|---|---|---|---|
| March 2017 | 47 | 45 | 96 |
| June 2017 | 26 | 24 | 92 |
| November 2017 | 77 | 63 | 84 |
| Total | 150 | 132 | 91 |
2016
| Sitting | No. of candidates | No. passes | Pass rate (%) |
|---|---|---|---|
| March 2016 | 33 | 29 | 88 |
| June 2016 | 27 | 26 | 96 |
| November 2016 | 59 | 52 | 88 |
| Total | 119 | 107 | 90 |
If you believe there was an administrative or procedural irregularity during your examination and would like to appeal the assessment decision please visit our Appeals page.
Please note that an appeal must be made within 28 days of the examination.
Once you have completed your training and passed the TCFA in independent prescribing, you can start using the DipTp(IP) affix. However, before you start practising in independent prescribing, you need to apply for specialist registration with the General Optical Council (GOC)
The examination is 102 minutes long and consists of 75 questions + 10 pilot questions, which are grouped into scenarios following a patient journey. Candidates will be introduced to each scenario with a one to two paragraph construct, which will provide the information needed to begin answering the questions. The questions then follow and further information (developments) may be provided as the patient journey continues. The questions are all multiple choice (MCQs) but can be either single best answer questions (where one single option will be correct) or multiple best answer/‘pick N of many’ questions (where there may be two or more equally correct options).
Example of single best answer question:
Which one of the following is the most likely diagnosis?
Example of multiple best answer/pick N of many question:
Which three of the following tests would be most appropriate to aid your diagnosis?
The TCFA is a key features examination. This is a method of testing clinical decision making in a structured way using realistic patient presentations followed by a series of multiple choice questions. Each question is categorised according to the skill(s) being tested e.g. interpretation of clinical signs, diagnosis, management etc and the severity of the condition(s) being treated within the scenario. The questions test the application of knowledge that is synthesising and interpreting information and problem solving, rather than simply recalling facts.
The College’s Clinical Management Guidelines (CMGs) are used to drive content for the examination. These are guidelines concerning the diagnosis and management of a wide range of eye conditions that present in primary and first contact care. The questions in the examination are written by IP-qualified optometrists and 2
ophthalmologists; the topics are drawn from and are in line with the College CMGs, but are also based on practitioner experience, therefore ensuring candidates can apply their clinical knowledge of the guidelines to real-life scenarios. Therefore, while preparation should certainly involve revising the CMGs, bear in mind that the examination is not simply assessing candidates’ knowledge of them, it is testing their ability to apply them in practice, hence the format of the exam being broken into scenarios or individual patient journeys. The TCFA ensures a common standard from candidates who have completed different accredited university modules and different clinical placement experiences and is therefore designed to test application of knowledge gained from these around the conditions contained in the CMGs. The examination assesses application of knowledge in real-life scenarios, with the CMGs acting as the evidence-based framework for your decision making process.
Please be aware that the CMGs are regularly updated every few months; if this happens once the questions have already been set for a forthcoming examination, the College will contact all candidates to confirm the versions of the CMG(s) that they should be revising.
Please see below for specific advice on revising for glaucoma related questions.
It is a GOC requirement that 33% of the examination questions in the TCFA are based on glaucoma. This point clarifies how these questions relate to national glaucoma guidelines, namely the NICE and SIGN guidance. As mentioned above, the content of the IP examination is drawn from the College’s Clinical Management Guidelines, and so these should form the main basis for revision for all areas of the examination, including glaucoma-related questions. The College does not recommend that candidates solely revise the NICE and/or SIGN guidelines, however, knowing NICE and SIGN guidelines may be beneficial in helping candidates weigh up the most appropriate answer for each question. Please note that no questions in the examination will include information or answer options that may be judged ambiguous or contradictory between the NICE and SIGN guidelines.
The paper is standard set following the examination by the Independent Prescribing Panel. The Angoff method, an internationally-recognised standard setting methodology, is used to set the standard. The Angoff method allows the difficulty of each question to be taken into account when determining the pass mark of the paper. Each question is scored on difficulty by a Panel of experts, which means that each paper has a unique pass mark. If, following the examination, any justified ambiguities in the paper are brought to the attention of, or noticed by the Panel, be this by statistical analysis or candidate feedback, then these will be factored in to the standard setting process of the examination. This may include considering and dismissing the ambiguity, accepting an additional answer as correct, scoring the question as very difficult or removing the question completely from the paper. It is important to emphasise that all these options must be supported by the majority of the Panel. Note also that candidates from different parts of the UK are not marked 3 differently based on their location. Any questions which are highlighted by candidate performance or by review by the Panel are discussed and possibly referred back for editing by the question development group.
The examination is run electronically on College laptops, using bespoke assessment software. When candidates arrive they will be allocated a laptop and will be able to complete a short practice exam to get used to the way the software works. When everyone has completed the practice test the examination will commence; candidates enter their individual ID number so that their answers and scores are saved both locally on the laptop and to a central server. Candidates will be presented with the construct of the first scenario and the first question, with answer options. Once the question has been answered the construct will move to the right hand side of the screen, where it will remain throughout the scenario. If necessary a short further development will then be displayed, followed by the next question. Again when answered the development will move to the right hand side of the screen under the construct, and so the patient journey continues to build. Scenarios are generally made up of between three and six questions and will then move onto the next scenario. There are generally between 15 and 20 scenarios in each examination. Please refer to the screen shot sample examination question on the College website which show exactly what the candidate will see.
We recognise that referral terminology can differ depending on where you practise in the UK. For the purpose of the TCFA, and in line with other College examinations, we use the below terminology.
Emergency: Same or next day
Urgent: Within one week
Routine: In due course
