Seven Pearls to Success for the OKAP Exam

By John W. Kitchens, MD

The OKAP exam is typically one of the most stressful parts of residency. During medical school, tests were used to determine competency and to measure you against your peers. Once you enter into residency, there are far fewer tests. This creates two issues: (1) There is more emphasis on a single test, as opposed to medical school where there were many and (2) You are out of the routine of daily reading and preparing for tests. The first issue creates anxiety and the second creates full-bore panic. This article is intended to give you an idea of how to prepare for the OKAP exam in a way that will lower your anxiety and panic levels.

Seven Pearls for the OKAP exam:

1. Preparation is a year-long process

There is no short cut to doing well on the OKAP exam. The most important thing is to read throughout the year. Begin with the Basic and Clinical Science Course (BCSC) books and read each and every day. Grand rounds and lectures are great for your knowledge as an ophthalmologist, but they are not comprehensive enough to cover all of the topics for this exam. During the first year of residency, I would try to read the BCSC books at least once. Later on (in the second or third year), if there are different sources that better fit your learning, then you can change and use those.

I would try to get the BCSC read about 6-8 weeks prior to the OKAP exam to allow for intensive review. This allows for a familiarity with all the material. You can then use the highlights, notes, photos from your BCSC to assist you in reviewing prior to the test.

2. Don’t get overwhelmed

It is easy to feel very overwhelmed prior to the exam. There is so much material to cover and early on in training the material will seem so foreign. Reading ophthalmology daily is vitally important. Even the most prepared will feel a certain sense of panic leading up to the test. Realize that this is normal and that everyone is feeling this way (although not all will show it).

Try not to give up on your system of preparation. Too many times people will try to alter their review materials or way of preparing at the last minute. Don’t let this happen to you by being prepared. Also, don’t use too many different sources to learn from at the last minute.


Don’t get “freaked out” by what others seem to be doing or how much they seem to know. Medicine is a competitive field and there are people throughout your training that will feel the need to make others feel insecure. Most of the time, this is because they feel insecure and unprepared. It is best to be humble and stick with your plan of preparation.

3. Don’t ignore some critical subjects


Pathology, tumors, and uveitis often fall into this section. This is often because most programs don’t have extensive clinical rotations in these subjects. This means that there is little clinical teaching in these areas and little time spent on these during rotations. Keep in mind that there will be as many pathology questions (if not more) than on pediatric ophthalmology. It is a natural tendency to want to study the subjects that you are most familiar with, so don’t ignore these important areas.

That being said…

4. If anything must go, let it be optics

Please keep in mind that this is my own opinion and that thorough emphasis should be placed on all subjects. However, if you are running low on time, optics has the lowest yield as far as time commitment is concerned. It is really tough to be familiar enough with all of the formulas and other details with optics in a short amount of time. Furthermore, there are few clinical faculty/rotations that will be held responsible if you do poorly on optics (unlike subjects such as retina, pediatrics, cornea, etc.). I can definitely recommend the book Last Minute Optics by Drs. Hunter and West as a great one or two day read prior to the test.

In other words, if the choice comes down to knowing Prentice’s rule or knowing the white dot syndromes, you should know about the latter.

5. Use practice questions

Practice questions are a great help in providing various types of questions that will be asked. They can also give you an idea of how the test is structured and how long you need to spend on each question during the test to get done in time.

If sample questions are done too late in the process or when you are not prepared, they can cause anxiety and panic. What I would recommend, is that a first round of sample questions be done 4-8 weeks prior to the test (to see what sorts of questions are emphasized) and a second set of questions be done 1-2 weeks prior to the test to get your timing down. The best source of questions is the back of the BCSC books. Another good source is a book entitled: Review Questions in Ophthalmology by Drs. Chern and Wright.

It should be noted that there are some people who learn very well by doing question books. If you are this type of person, then stick with what works for you.


6. What to do just prior to the test

It is great to leave a little time prior to the test to review your notes and look through a good atlas a week or two prior to the test. You should also take time to flip through the BCSC books and look at all of the photos.

7. This test is not everything

The OKAP exam is important in assessing general “book” knowledge of ophthalmology. It cannot be emphasized enough that this test does not measure your ability as a physician. If you do poorly on the test early in your training, you will have time to improve. It is important to learn from the things you did incorrectly (lack of reading, incorrect materials, optics) and work on them. Furthermore, if you do well do not let it go to your head and do not brag about it to your colleagues. Remember there are many more tests to come in future years. Keep in mind that the purpose of this test is to prepare you for the written board exam.

Review previous articles on this topic.