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If you’re starting to make time in your already busy schedule to study for the upcoming Ophthalmic Knowledge Assessment Program (OKAP) examination, you may be wondering what your performance will mean. To help answer that question, we talked to a few experts to help put the exam – and your preparation for it – in context. Next month, our editorial board will share their tips for doing your best on the OKAP.

Evaluation Tool … and Prep Test
One of the most basic ways the OKAP matters is that it tells you about how you’re doing. “[The OKAPs] provide self-assessment in terms of where you stand as compared to those in your same clinical year,” said Hoon Jung, MD, a clinical assistant professor of ophthalmology at the University of Buffalo. “If you are deficient in one area of the OKAPs, you know where you need to focus in order to round out your general knowledge and skill set.”

Natasha Herz, MD, a cataract and cornea specialist and YO Info's editor, agreed. “It definitely showed that I had weaknesses in areas, such as pediatric ophtho, that improved the next year after I'd had a chance to do that rotation,” she said. “That's not to say that I didn't study that area every year. But after receiving more instruction in that area, it definitely showed up on the OKAP by helping me get a higher score in that area.”

Indeed, helping residents (and their instructors) identify knowledge gaps was the reason Melvin Rubin, MD, first developed the OKAP, some 40 years ago. An ophthalmologist at the University of Florida in Gainesville, Dr. Rubin wanted a way to evaluate how well residents in their program were doing. His exam quickly caught on (within 10 years, the majority of national eye-training programs had adopted the OKAP) and has since become not just a valuable assessment tool, but a predictor of future performance.

Several years ago, staff in the University of Iowa ophthalmology department noticed that they had great residents who were not doing well on the OKAP. According to Thomas Oetting, MD, this caused them to question if there was any reason to worry about their OKAP scores.

After researching the topic, Dr. Oetting and his colleagues discovered a significant correlation between the OKAP scores from the third year of residency and passing the medical boards. In fact, they found that the best predictor for passing the American Board of Ophthalmology’s written qualifying exam (WQE) is your performance on your third-year OKAP.

Dr. Jung concurred. “I found the level and depth of information as well as the test style of the OKAP to be very comparable to the written part of the board exam,” he said. “The preparedness and style of test taking of the OKAP is an excellent dry run for the WQE.”

Others are increasingly picking up on that correlation. If the best predictor of passing the boards is a resident’s third year OKAP score, the second best predictor is the second-year OKAP score. Increasingly, fellowship programs look at second-year scores when residents apply for fellowships.

“This is why we tell our residents that the OKAPs are more of a high-stakes endeavor, particularly in your second year, than ever before,” Dr. Oetting said.

“Historically, the OKAP was not designed to compare one resident to another,” he said. “It was simply a test to determine if residents are progressing appropriately. But, over the past 10 years, it has taken on a new meaning and is being used as a differentiator.”

However, when it comes to evaluating one resident versus another, Dr. Jung doesn’t think the OKAP should be the only tool used. “It really raises a larger philosophical question,” he said. “How do we assess and maintain relevancy in ophthalmology and how do we evaluate for basic academic and clinical knowledge?”

“This is why we try to focus on well-rounded residents here at Iowa,” says Dr. Oetting. “In addition to emphasizing clinical skills and patient needs, we also recognize the importance of test taking and the OKAPs as tools for passing the boards.”

While they aren’t the sole (or even arguably the best) measure of what makes a good resident, the OKAPs are an unmistakable indicator of medical knowledge. But, perhaps even more importantly, they are an undisputed predictor of a resident’s likelihood to pass the boards.

And, let’s face it, no matter how spectacular your clinical skills and bedside manner, if you cannot pass the boards, there will be limits on your ability to practice.

In Summary
As the OKAPs begin to take on a new heightened emphasis, there is naturally going to be some resistance. But when you really look at why the OKAPs were created (to help residents and residency programs evaluate academic performance and to prepare residents for the boards) and how they are being used today, you’ll notice that not much has really changed.

Next month: Look for tips on doing your best on the OKAP, as the YO Info editorial board shares their test-prep pearls.

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About the author: Kimberly Day is a freelance health writer and medical editor and frequent contributor to YO Info. She is the co-author of Hormone Revolution and ghostwriter of Eat Papayas Naked.

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