Golden Pearls for the OKAP Exam

By Ashley N. San Filippo, MD and Vinay A. Shah, MD

April signifies more than just warmer weather for most ophthalmology residents—this month represents the culmination of all of your studying and hours of preparation into one 250-question test. The Ophthalmic Knowledge Assessment Program (OKAP) examination is given annually across the United States and Canada by the American Academy of Ophthalmology to ophthalmology residents, each of whom vary in their methods and intensity of preparation. Residency programs vary in attitude toward this exam. Some may gear lectures toward popular OKAP topics, while others may provide little or no “official” preparation. No matter what type of program yours is, it’s important to remember that this test in no way tests your ability to be a great clinician or surgeon. However, it does give you three chances to practice for the “real” boards, which you will want to be prepared for. The following are some brief tips for achieving success in the OKAP exam.

Year-long preparation is the key: Read the Basic and Clinical Science Course (BCSC) books throughout the year (yes, all of them) if possible. This does require a good deal of discipline and time, and if you’ve done this, you’ll be very well-prepared. If you have been unable to keep up a rigorous reading schedule throughout the year, review books are an option for you. However, be sure to keep the BCSC books nearby as a reference if needed. If you are using a review book, use it early along with your BCSC books if possible and take notes in the margins. This will make for easier studying when it comes closer to exam time. Although there are several popular review books available, we particularly found Review of Ophthalmology by Friedman helpful. The content of this book closely mimics that in the BCSC.

To lessen the massive load, here are a few tips for abbreviating your BCSC reading (Note: These tips are based on the personal opinions of the authors. These methods are by no means a comprehensive guide to OKAP studying):

• Skip the General Medicine book, especially if you’re a first year—most of these test questions will be easy to answer if you’re just coming off an internal medicine-based internship. Plus, this topic is not covered on the written board exam.


• The optics book is HUGE, so use it as reference only. Most of what you need for the optics portion of the test can be covered by reading Last Minute Optics: A Concise Review of Optics, Refraction and Contact Lenses by Hunter and West and by doing a few review problems from a question book.


• Lightly skim the refractive book. This topic is integrated into optics and the cornea sections so there will be only a few questions that may come from this book.


• The Neuro-ophthalmology book is not the best-written book. You may decide to skip this book altogether in favor of a more concise book like Neuro-ophthalmology Review Manual by Kline and Bajandas.


• Most of the contents of the Fundamentals book are contained in the other subject books. You can use this book to refer to if you need a refresher on a fundamental topic.


• Don’t skip the questions at the end of each BCSC book—these tend to be very similar to those on the OKAP exam.

You know how to study: You haven’t reached this point in your life without knowing how to prepare for tests. What works for your co-residents may not work for you. If you learn best by discussion, find someone who works the same way and bounce topics off of each other. If you learn best by listening and can’t stand the thought of reading for hours, you may want to incorporate a review course into your strategy (If you attend the SAOC course in San Antonio, TX, you will be provided with lectures in MP3 format). If you are more of a passive learner, a great resource is Ophthalmology Buzzwords™. No matter what kind of study methods you prefer, try to keep the basic study principles that are specific to you in mind when you design your study plan. And speaking of study plans…

Have a study plan: Even the most disorganized resident can benefit from a rough outline of what to study and when. A study schedule is a great idea for your final months or weeks, and even days of studying. When creating a schedule, keep in mind your call schedule, vacations, and other occasions where you may not get much time for test prep. Having a plan also guarantees you’ll give equal time to all subject areas and not just the ones you enjoy more. If this is your second or third year taking the OKAP exam, you can use this schedule to put extra emphasis on your weaker areas.

Know the topics covered: The subject areas covered in the OKAP exam differ from the topics in the BCSC. They also differ from the subjects on the written board exam. There are 11 subject areas covered in the OKAP exam, each having equal emphasis: General Medicine; Fundamentals and Principles of Ophthalmology; Optics, Refraction, and Contact Lenses; Ophthalmic Pathology an Intraocular Tumors; Neuro-ophthalmology; Pediatric Ophthalmology and Strabismus; Oribit, Eyelids, and Lacrimal System; Cornea, Lens, and External Disease; Intraocular Inflammation and Uveitis; Glaucoma; Retina and Vitreous. Knowing what you’ll be tested on allows for better time management when studying.

Practice questions: This is important to start early. If you’ve done many questions, you’ll start to see patterns and popular topics. These often mimic testing patterns on the OKAP exam. Once you’ve begun to recognize these patterns, you’ll start to think of them in your reading. You’ll start to think to yourself, “I saw several question about this, I should pay close attention to this topic” or “how can this bit of information be formed into a question?” Once you’re thinking like the test-maker instead of the test-taker you’re well on your way to success. Some popular question sources include Review Questions in Ophthalmology by Chern and the Massachusetts Eye and Ear Infirmary Review Manual for Ophthalmology by Jager and Lamkin.
Know what things “look like: There are many photographic questions on the OKAP exam. Ask yourself when reading a description if you’ve actually seen this disease process before, either in person or in a photograph. If not, find a picture. A few good sources for this are Kanski’s Test Yourself Atlas in Ophthalmology, and http://www.redatlas.org/. Any atlas will do. If all else fails, you can always do a Google image search.

Be conservative: You’ll find that during the OKAP exam that there will be many management questions that will appear to have more than one correct answer. Don’t be surprised or panicked when you see this. A good approach is to choose the option that is the least aggressive, even if this is not the most definitive treatment. Observation and a cycloplegic drop will almost always be the answer over taking the patient to the operating room. Thus, when studying, pay close attention to initial, conservative management.

Last minute studying does help: Some topics deserve some last minute attention because they are high-yield and they are hard to keep in your memory for more than a week. These topics include the phacomatoses, optics formulas, chromosomes and inheritance patterns, embryology, and glaucoma medications (especially side effects). Study these topics in the last week before the test—you’ll be surprised how many of these will show up.

Relax the day before: It’s unlikely that any studying will significantly benefit you on this day, and it may actually harm and confuse you. Do something mindless and relaxing that evening so you’ll sleep well and be refreshed on test day.