• Oral Board Exams: Recent Changes and Study Tips

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    Congratulations! You’ve passed the Written Qualifying Examination (WQE) with the American Board of Ophthalmology.

    The euphoria of learning you passed, however, may soon be overshadowed by the dread of studying for yet another test: the oral exam. The good news is with a little review and practice, you can ace that test as well.

    The oral board exam is arguably the most stressful assessment an ophthalmologist has to take. This is not necessarily due to the material, but the unfamiliar format of the test. In the past, details about the test were hard to come by. An AAO 2019 session specifically on the oral boards included a handout that may clarify questions and misconceptions candidates have about the written exam and the oral boards.

    Schedule Change

    First some updates on the oral boards. In July 2019, the written exam date has moved to September. Once administered two times a year, the oral boards will now be given only once each year beginning in 2020. This year, it is scheduled from March 19 to 21.

    Officials hope that the change in the testing timeline will allow graduating residents, if they wish, to become board-certified within nine months of graduation, as opposed to 16 to 24 months with the previous timeline. Residents have up to seven years after graduating to complete board certification, so you have ample time.

    Test Format

    The oral board examination is given over a half-day and divided into six, 25-minute-long sections, each focused on a specific topic area. Topics covered during the exam are: anterior segment; external eye and adnexa; neuro-ophthalmology and orbit; optics, visual physiology and refractive error; pediatric ophthalmology and strabismus; and posterior segment.

    Each room will have a single topic, and in each room, candidates will be seated face-to-face with one or two examiners. The candidates are presented a series of cases or clinical scenarios on a tablet and asked how they would care for a patient. 

    Candidates are assessed on their ability to demonstrate their skills in data acquisition, diagnosis and management, according to the ABO. It’s not enough to just arrive at the correct answer, if one exists, but also to be able to provide a differential diagnosis, offer a management plan and counsel a patient on what to expect.

    Read Up for the Exam

    Where to begin? Start off with the Academy’s Board Prep Resources for Ophthalmology Residents, which lists free and paid member resources, such as the Wills Eye Manual and question banks from the Basic Clinical and Science Course™ Self-Assessment Program.

    Books

    There are several popular books that candidates use for oral boards studying. “Ophthalmology Clinical Vignettes,” by John Pemberton, MD, is in its second edition and contains 113 clinical cases with color photographs and sample answer responses.

    Case Reviews in Ophthalmology,” by Neil Friedman, MD, and Peter Kaiser, MD, is also in its second edition, and offers 140 clinical case scenarios with photographs and specific questions and answers.

    Ophthalmology Oral Board Review,” by Damien Luviano, MD, contains 65 cases, including two sample oral examination cases with accompanying audio files in the eBook portion.

    The Osler Institute also offers its “Ophthalmology Oral Board Review Study Manual,” by Damien Luviano, MD, and Charles Wykoff, MD, PhD. It contains 50 cases with answers organized in the answer format taught in the Osler review course.

    In addition to these books written specifically for oral boards studying, many candidates also use “Last-Minute Optics to review optics concepts and “The Wills Eye Manual to review common diagnoses and their diagnosis and management; and ophthalmology atlases to practice rapid image and diagnosis recognition.

    Practice With a Study Partner — Or Yourself

    Although reviewing cases independently with the books I mentioned is a good way to get started, many candidates struggle with how to present their cases in a detailed and concise fashion in person. There is no substitute for practicing your public speaking skills before you have to take your exams.

    Find someone who is also taking the test (like a trusted co-resident) and present practice cases to each other, either in-person or via video chat. Not only can you review test content with each other, but presentation length and style can be evaluated and improved when practicing orally.

    If you don’t know anyone else taking the test, simply practice on your own in front of a mirror or record yourself on a mobile phone. Even people used to public speaking say practice is key to connecting with your audience.

    Online One-on-One Coaching

    A newer resource for a more structured way to practice one-on-one with someone online is Eye To Eye Board Review. A startup founded by two former co-residents, the service offers one-on-one webcam-based sessions with a tutor with a paid subscription.

    Sessions start with cases in “tutor mode.” Candidates get feedback after each case presentation. The sessions then progress to nonstop cases in “test mode” mimicking the format of the real examination.

    This service may be useful for candidates looking for more personalized coaching without the expense and time of attending a commercial test review course. Flexible scheduling may also be more appealing to those unable to attend a traditional course.

    In-person Review Courses

    Candidates looking for more intensive coaching sessions may be interested in live, in-person mock oral sessions.

    Perhaps the most well-known is the Osler Institute course, offered the week immediately before the board exam. Registration includes a three-day intensive case review course and two, 25-minute public mock oral sessions.

    The course uses a structured answer format to organize the examinee’s thoughts and ensure that all the pertinent information gets discussed. You can also purchase additional public or private (one-on-one) mock oral sessions. This course can be helpful in beating pre-performance nerves — once you present cases in front of 100 of your peers, you’ll be well-groomed to present on the actual test day.

    The University of Colorado in Aurora, Colo. also offers a true full-length mock oral preparation course. It takes place over a half day, and participants go through a three-hour exam comprised of six, 30-minute sessions presenting up to 10 cases to a faculty member. At the end of the exam, each participant’s performance is reviewed and feedback given on improving presentation techniques.

    Similarly, the San Antonio Ophthalmology Course offers a mock oral course at the conclusion of its review course. Registration includes four hours of small group testing, focusing on “practice scenarios, listening to others and critical feedback for effective communication.” However, space is limited to only nine participants per year.

    The ABO prohibits anyone giving these courses to be involved with any of the board’s activities or to serve as one of its examiners, according to the board.

    Conclusion

    Although the thought of taking a three-hour long oral examination can be daunting, you can find lots of resources to review ophthalmology content and learn new test-taking strategies. Before spending money on any program, ask your peers and mentors which they would recommend. Your pocketbook will thank you.

    Remember, the key to acing the exam is to become comfortable with the test format and delivering case presentations in a complete and concise manner. Don’t forget: Find a friend and practice, practice, practice!

    Further Resources

    Board Prep Resources for Ophthalmology Residents, American Academy of Ophthalmology

    New Timelines Introduced for Written, Oral Examinations, American Board of Ophthalmology

    Oral Board Exams, American Board of Ophthalmology

    Textbooks

    Bagheri, Nika, et al. The Wills Eye Manual: Office and Emergency Room Diagnosis and Treatment of Eye Disease. Wolters Kluwer Health

    Friedman, Neil J., and Peter K. Kaiser. Case Reviews in Ophthalmology.

    Hunter, David, and Constance West. Last-Minute Optics: A Concise Review of Optics, Refraction, and Contact Lenses Second Edition

    Luviano, Damien Matthisen. Ophthalmology Oral Board Review. Wolters Kluwer, 2019.

    Luviano, Damien, and Charles C. Wykoff. Ophthalmology Oral Board Review Study Manual. The Osler Institute

    Pemberton, John D., et al. Ophthalmology Clinical Vignettes: Oral Exam Study Guide II. Crimson House Publishing LLC, 2015.

    Review Courses

    Eye to Eye Board Review

    Mock Oral Board Examination, University of Colorado

    Ophthalmology Mock Oral Course, The Osler institute

    San Antonio Ophthalmology Course, The Geneva Foundation

    Andrew A. Kao, MD

    About the author: Andrew A. Kao, MD, is a comprehensive ophthalmologist and ocular oncologist in Bakersfield, Calif.