The American Academy of Ophthalmology (AAO) Ophthalmic Knowledge Assessment Program (OKAP) is a perennial source of angst for many trainees. Advice and tips for success flow freely from many sources. Proposed study schedules can be discouraging. The psychological aspect of test performance is often overlooked in preparation plans. Below I will share my perspective on the exam and how you can craft your path to success.
Understand the OKAP focus
The format of the OKAP has remained relatively constant for many years, even during the transition from a paper-based to an electronic exam (my ophthalmology residency years spanned the transition). What has changed over the years is the content focus of the exam. I state this because I think it is important to rely more on advice from junior faculty, fellows, and your senior residents who have recent experience with the exam. I have observed well-meaning senior faculty share outdated advice and strategies for this exam and deliver low-yield review lectures
“The AAO Basic and Clinic Science Course (BCSC, aka the Manuals) has come a long way since the thin volumes of decades past.”
“Read the manuals twice a year” is no longer a feasible plan. Nor is “read Adler’s (Physiology of the Eye)” a productive use of OKAP prep time, despite being an excellent reference text.
Secure your stacks
As a primarily paper-based studier, my preparation plan involved “securing my stacks”. This entailed organizing a study pile for each subspecialty area so that my study materials were organized, and study time was not wasted searching for resources. With resources like Microsoft OneNote and Evernote, digital organization is easier than ever. This curation takes effort in the months ahead of the exam but requires very little time if done on an ongoing basis.
In some cases, my stack contained the AAO BCSC volume plus a few sheets of additional notes. For other areas where I found other sources to be superior to the BCSC volume, the stack would include documents from review courses supplemented by additional sources. For this approach to be effective, reading should continue throughout most of the year so that content sourcing is not adding an overwhelming task ahead of the exam date.
Another tip is to attend a review course (or courses) early in your training if permitted by your program. My co-resident and I took advantage of a week-long review course in our junior residency years. This fed the stacks with great content. This content was also very familiar by the senior years after having been read a few times.
Variation in chronotypes is now well established. Although your schedule is mostly prescribed by your residency program, you may have some control of when to read. Understanding your chronotype can increase the chance of adhering to a planned reading schedule.
If waking from sleep each morning is a constant battle, planning to study an hour each morning is unlikely to be successful. Similarly, if you are someone who takes a lot of time to settle into a reading flow and eliminate distractions, chunking larger blocks of study time on weekends may be more effective than shorter, more frequent scheduled reading periods.
Set up practice exams
The psychology of test-taking should receive some attention during your preparation. This may range from brief moments of reflection to more directed attempts at improvement. Many trainees writing the OKAP will have had proven records of success with NBME and USMLE standardized exams. Use these past successes as a confidence builder on your first attempt at the OKAP but also don’t overlook the hard work you invested to achieve prior success.
Practice exam content is available through a variety of sources and can be part of an effective preparation plan. However, these low-stakes simulated exams may not enhance your psychological preparation. To increase the stakes, consider seeking out a mentor who will invigilate a simulated exam and review the result with you. This will help simulate exam day pressure. I would suggest making the time limit tighter than the OKAP-allotted time too.
This practice may help you identify whether you are prone to choking or panicking. As distinguished in Malcolm Gladwell’s The Art of Failure, choking (excessive carefulness and second-guessing) and panicking (inadequate practice and experience) require different adjustments to improve performance.
As a supervising mentor, I would also escalate and add some disruptions to the planned simulated tests if multiple sessions were planned. Disruptions are known to occur on exam day (fire alarms, technical glitches, etc).
I recall one year that a question appeared describing a clinical scenario of a clotting disorder and the answer required selection of the appropriate investigation. Our resident group struggled to settle on a convincingly correct answer during our post-exam recovery session at Dairy Queen. By convenient coincidence, a hematology fellow was booked as a patient in our Saturday emergency clinic that followed the exam. Surely our mental anguish was to be relieved. She also could not answer the question! Nor did a subject area deficiency appear on our returned OKAP reports months later.
The point here is that you should not have your exam flow disrupted by a single question that may not be answerable and may not be included in your exam score.
Keep an eye on the big picture
All advice is prone to common biases and fallacies. My advice will be no different, yet I hope that considering some of the points will help balance your ideas about preparing for the OKAP. If you think this exam is unimportant, I am sure you will find agreement. If you think this exam is extremely important, I am sure you will find agreement. And the truth probably lies somewhere in between.
“Finally, it is important to keep in mind the big picture of your journey to becoming an ophthalmologist.”
The OKAP is one measure of your performance. A great score can add to a portfolio of excellence when applying for fellowship. A great score in a subject area may validate your strong knowledge in an area deemed to be weak in an evaluation by your program.
There is no score that will outweigh the importance of taking care of your patients, colleagues, family, and yourself.
