Should I include everything in my Ophthalmology portfolio?

No. The instinct is to submit everything you have ever done, on the theory that an assessor will find the good parts and ignore the rest. That is not how the portfolio is marked, and acting on it can cost you points you had already earned.

The useful version of the question is narrower: given a specific piece of work, does it belong in the portfolio, and if so, where? The rules for creating your portfolio set out what to claim, where to place it and when to stop, in a few lines each. This post takes each of those rules further. They come from SmartOST's portfolio webinar, and every factual point below is checked against NHS England's Ophthalmology ST1 self-assessment and supporting evidence page, the 2027 guidance this post calls the evidence folder.

Read the evidence folder line by line

Every decision below is a decision about one document, and the evidence folder sets the conditions that document has to meet. Read it before you sort anything, not after, and read it for wording rather than for gist.

The gist reads as "presentations score points". The wording reads as three separate lines: regional presentations at 1 point each, national at 2 and international at 3. It then adds that "Meetings in non-UK countries where explicit evidence is not presented as to the international nature of the meeting are scored as national or regional meetings." A candidate who skimmed uploads the certificate and expects 3 points. A candidate who read it uploads the programme that shows the meeting was international.

Quality improvement works the same way. A project scores at most 1 point if you were not clearly its lead, and the guidance adds that "being first listed in authors on documents is not proof of being lead on a project". That one clause decides what your supervisor has to put in writing.

One of the webinar's presenters says almost every portfolio they have looked at has some mistake in it. A mistake of this kind is a point lost to reading rather than to achievement. A practical way to read: go domain by domain, and for each line write down the evidence it asks for in its own words, before you look at a single item of yours. The evidence rules for each domain are set out in full, along with what the 2027 round tightened in what changed in the 2027 evidence folder.

Go back further than this year

Before you go looking for new work to do, go backwards. An audit you ran in a first foundation post. A student project nobody has asked you about since. A teaching session you gave once and never thought about again. First place in the RCOphth Essay Prize for Foundation Doctors, which earns a point under Ophthalmology specialty links.

Most of the form carries no time limit, so work you stopped counting years ago is still claimable. Two parts of it do carry one, and they are worth checking before you spend an evening digging. The 2027 guidance asks for your best quality improvement project or audit "performed within the last 3 years of the interview date". For multi-source feedback it says: "The MSF must have been taken place within 18 months of the interview date if the candidate has been in clinical posts for this period." A candidate not currently in a clinical post who has no MSF in that window "should include the MSF from their most recent clinical post." Everything else is fair game however old it is.

That makes an afternoon of remembering the best rate of return available late in the cycle. It produces items you already hold the evidence for, which is not true of anything you start this month.

Prizes from your degree need a second look before you claim one. For 2027 a degree prize scores for "1st in the final year (not module or other part of a year)", and only where fewer than 15% of the year achieve it. A first from an earlier year of the degree does not score there.

Place everything in one pass

Most items have one obvious home. Some have two. A peer-reviewed Ophthalmology paper you wrote as first author can go under publications or under Ophthalmology specialty links. A case report has only one: publications takes peer-reviewed original research or systematic reviews alone, so an Ophthalmology case report scores under specialty links, as first author. A meeting can sit under presentations or under specialty links, and the guidance says of it: "Please choose which domain to include the work in." A published audit can earn 5 points under quality improvement, and is then "not to be added to Publications or Presentations sections".

Each piece of work is claimed once, and each domain has a cap. How each domain is scored sets out both. What follows from them is the part nobody writes down: where one item should go depends on where all the others have gone. Placing items one at a time, each in its most natural home, is how a candidate ends up with a full domain and an empty one, holding work that could have scored in both.

So place them together:

1. List every item you intend to claim.
2. Beside each, write every domain it could legitimately reach under the evidence folder's wording, not just the obvious one.
3. Place the items that have only one home first, and total each domain against its cap.
4. Use the items with two homes to fill the domains that still have room.

Step 2 is the one to do slowly, because an item's second home is what lets you move it when its first fills up.

Use a supervisor letter to settle borderline work

Between the work that obviously scores and the work that obviously does not sits a third pile: work that meets an evidence type in substance, but whose documents do not show it. Borderline work usually fails on that ambiguity rather than on what you did.

The guidance is plain about how ambiguity is resolved: "if there is any doubt, points will not be scored unless third party or objective supportive evidence is presented." A supervisor letter is that evidence. A letter naming the evidence type, the dates, the setting and what you actually did removes the doubt before an assessor has to weigh it. What to ask a supervisor for has a template you can send.

There is one place a letter cannot do the work on its own: 4 or 5 points for quality improvement or audit. The 2027 guidance says: "Your supervisor's letter stating measurable changes/ improvements were made from your audit or QIP is not enough evidence for 4 or 5 points, please include data demonstrating this." Four points needs "specific demonstration of improvements to practice", or "completing the audit loop and implementing change". Five needs a "published audit in peer-reviewed journal" or "QI guidelines implemented supra-regionally with clear evidence of impact". At that level, bring the data, such as before and after figures, and keep the letter for what it still has to confirm: that you led the project.

Push a little, but only where you can prove it

It is fine to claim borderline work. The test for whether an item is borderline or simply does not qualify is whether you can point to the line it meets and name the evidence that will confirm it.

• Push when the work met the condition and only the paperwork is thin. A teaching session with no feedback forms, delivered under a consultant who can say so in writing, is borderline. So is a project you led whose write-up never named you as lead.
• Do not push when you would need the letter to say something that did not happen. A session you attended rather than taught is not borderline teaching, and no letter makes it so.

Pushing on everything is a different move. Every item you add for the sake of it has a cost, and the next section is about that cost.

When to stop adding

Three rules point the same way: take out what will not score, stop feeding a domain once it is capped, and do not pad. They are one decision seen from three sides, which is whether an item earns its place.

Take out what clearly will not score

An item that matches no evidence type does not sit there harmlessly. It is one more page between an assessor and the pages that do score. If you cannot name the line in the evidence folder an item meets, it comes out, however much work it took.

Once a domain is capped, more items earn nothing

Points past a domain's cap are lost. A fifth presentation in a domain you have already filled scores nothing there, and it is not free either: it is surplus, with the cost described below.

That does not make the item worthless. An item can still be placed under another domain it qualifies for that has room, and that is where it scores. Before cutting a capped item, check its second home. Where it has one, the question is which domain has room rather than which is the better fit. The caps and the claim-once rule are on how each domain is scored.

What overfilling actually costs

Two different things, and they are worth separating, because one is published and one is not.

The published one. The 2027 guidance gives each domain a list of contents, and says: "Candidates have been advised to follow the list of contents as precisely as possible as marks may be deducted for including unnecessary information."

Read that closely, because it is narrower than it first looks. The published penalty is for putting in material the list does not ask for. It is not a penalty for the portfolio being thick. Padding a domain with things nobody asked to see is the stated risk. Holding a lot of work that the list does ask for is not.

The one that is not. The webinar's presenters go further and say that excess shows up as a poor result in overall portfolio layout and quality. That is the presenters' reading of how portfolios are marked, and nothing in the guidance states it. The published description of that domain is one sentence, "How the portfolio is presented in layout and organisation will be assessed", and it says nothing about how much you include. Weigh it as experience, which is worth having, but do not treat it as a rule you can look up.

Either way the conclusion is the same. Surplus is not free, so it has to earn its place like everything else.

A test for each item

Three questions, in this order. If an item fails the first, the others do not matter.

1. Does it match an evidence type? Not "is it impressive", not "did it take a long time". Does it meet the stated conditions of a line you can point to in the evidence rules?
2. Does a domain it qualifies for have room? If every domain it could go in is at its cap, it scores nothing wherever you put it.
3. Can you prove it? Where there is any doubt, no points without third party or objective evidence. If the certificate is lost and the supervisor has moved on, the honest answer may be that the work does not go in.

Anything that passes all three goes in. Anything that fails the first comes out. The middle ground, work that passes one and two but has thin proof, is where a supervisor letter earns its keep, except at 4 or 5 points for quality improvement or audit, where the data has to come too.