10 Tips to Score Well on the OKAPS and the WQE

Why? The ophthalmic knowledge assessment programs (OKAPS) serve as prep examinations for the written qualifying exam (WQE) which must be passed in order to become board certified by the American Board of Ophthalmology (ABO). Once I reached the WQE, I felt that I had already studied for and taken the exam three times before. By preparing diligently for each of my OKAP exams (well… at least 2 of the 3), I found the WQE to be unintimidating and straightforward. 

Considering that between 10-17% of 1st time test takers and 58-72% of repeat test takers fail the WQE, it would be a mistake not to take the OKAPS seriously- particularly considering how competitive and bright ophthalmology residents are today.  You can find recent board pass and failure rates here.

Secondly, the OKAPS are still utilized by some competitive fellowships (e.g. retina and oculoplastics) to help stratify candidates. While OKAPS were designed to be a self-assessment tool and some fellowships respect that, other fellowships still want to know your score. Unless you know with certainty that you don’t plan to pursue one of these fellowships, it would be prudent to study hard for the OKAPS to keep your career options open. 

Finally, studying for the OKAPS every year is a fantastic way to enhance your ophthalmic knowledge base. While there is some esoteric material on the OKAPS, most questions are clinically relevant. There is no doubt in my mind that preparing for OKAPS yearly made me a better clinician.

“Cramming,” is an effective strategy that we have all employed for scoring better on exams. It is most effective for challenging topics requiring memorization of random facts. The downside is that long-term retention of knowledge gained from “cramming” is poor. Long-term learning is more tedious and requires understanding the material. I suggest employing both strategies in preparation for the OKAPS. 

Throughout residency training you should make a concerted effort to read the Basic Clinical and Science Couse (BCSC) from cover to cover every year. Many residency programs have a required reading program but if your program doesn’t, create your own. Over my three years of residency, I read through the series a total of approximately two times (skipping a few sections that I found incredibly boring). Another form of “long-term” learning is to look-up review articles and book chapters on unusual diagnoses that you see in clinic. Most people retain information better when there is some real life context associated with the material. 

While long-term retention is poor with cramming, most of us do it because it works. In the 2 months leading up to OKAPS I would try to go through as many questions as possible. In the last 2 weeks, I always made it a point to review select topics that are highly testable yet easily forgotten such as: corneal dystrophies, white dot syndromes, optics (sigh), and well-known studies in ophthalmology.

When answering standardized test questions, try to remember the ultimate purpose of the OKAPS and WQE. In general these exams are designed to ensure that test takers know how to recognize and treat serious ocular conditions. As a result, certain recurring themes exist such as: treat giant cell arteritis suspects with steroids before getting a temporal artery biopsy, a pupil-involving CN3 palsy (partial or complete) should be considered a posterior communicating artery aneurysm until proven otherwise, retinoblastoma should be a consideration in nearly every pediatric vignette you read, etc. When you read a question try to think to yourself, “What is the high yield teaching point this question is trying to make?” Of course, there are times this strategy does not apply such as pure memorization questions like “What is the average volume of the adult orbit?”

Standardized tests are designed to test ophthalmic mantra, or concepts that have withstood the test of time. They generally don’t test on controversial topics or recent research. When reading a clinical vignette, some examinees make the mistake of asking themselves “What would I do in my resident clinic if I were in this situation?” A better question to ask is: “What would my 10-year-old ophthalmology text book say that I should do?” Aside from the focus on time-honored concepts, standardized test questions go through a vigorous validation process that takes years. As a result of this, you should avoid referencing new research articles you read when answering test questions (particularly if the study contradicts long-standing beliefs). Chances are that the question you are answering was written many years before the recent journal article you are thinking about ever came out (review articles would be the exception).

Paradoxically, I frequently found myself wanting to study those topics that I was best at like neuro-ophthalmology and pediatrics. Answering practice questions correctly made me feel confident and prepared. The problem is that this strategy is illogical and self-defeating. For those of you who use ophthoquestions.com, you will quickly be able to tell (after taking about 400 random questions) your subjects of weakness based upon your scores. Identify your lowest 2-3 subjects and focus your time and energy on them. If you are really weak in a subject and time permits, then you may want to go back and re-read that entire book in the BCSC.

There are about 50 questions at the end of each BCSC. In my experience, there were at least 2-3 nearly identical questions from this pool that appeared on the OKAPS and the WQE every year. To skip over these “free money” questions would be foolish. 

Everyone learns differently. If you have a strategy that works for you then use it. If your strategy lands you in the bottom 50th percentile on your OKAPS then maybe it is time to try something different. Let me share the strategy that worked well for me. 

I love to learn by answering questions. Before ophthoquestions.com was launched (during my fellowship year), I studied for OKAPS by completing all of the questions in the Mass Eye and Ear question book and the Chern book. When I answered a question incorrectly or was forced to guess at a question, I would go back and review the relevant BCSC section on that topic. The aforementioned question books had flaws but they were the best product on the market at the time. The explanations in both books were often too short. At times I would encounter information in the explanation that contradicted some other reputable source and would leave me wondering what the right answer was. 

As a contributor to ophthoquestions.com from the beginning, we wanted to provide a better platform for learning. Aside from the transition to a more user-friendly web-based format, we also expanded our explanations. When possible we aim to include helpful mnemonics (some of which are contributed by our users) and test taking strategy to help you think through questions logically. 

Perhaps the greatest asset to ophthoquestions.com are its users. All of our questions and explanations are peer-reviewed daily by thousands of intelligent clients. As a result, we are constantly enhancing our content to make it a more effective learning tool; no other board review tool on the market offers that level of dedication to product development. 

Thanks to ophthoquestions.com, I found studying for the WQE simpler and more streamlined than studying for OKAPS. I got rid of the old question books but continued using my same strategy of questions from the OQ website and an easily searchable electronic version of the BCSC on my computer. 

The last 2 weeks before the test are the optimal time to study hard for your weakest topics. I personally always studied optics last by reading “Last Minute Optics” because I hate optics and can never seem to retain any of it for longer than 2 weeks. For you optics whizzes out there, I would suggest finding the topic that you dread the most and studying it last. 

On the day of the test you want everything to go smoothly. You want to avoid getting lost on your way to the test. I found that physically traveling to the testing location the day before made me more relaxed on the morning of the test.

Most people feel they perform best on exams when relaxed and focused. To help achieve this goal, I would always pack my bag the night before the exam after reading the testing center instructions carefully. Next I’d watch an inspirational movie (e.g. Rudy, Rocky, or Braveheart) before going to bed at a reasonable time. On the morning of the exam, I would arrive early to the testing center and sit in my car to review a few final esoteric, yet paradoxically high-yield charts including the white dot syndromes, corneal dystrophies, and optics formulas.