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How to Prepare for the NBEO Part III Clinical Skills Examination

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Those late nights of studying and those grueling hours of practicing in the clinical lab have led you to this: the NBEO Part III Clinical Skills Examination. You're ready—but who couldn't use a few more tips?

How to Prepare for the NBEO Part III Clinical Skills Examination
Just thinking about the NBEO exams fill me with the wave of anxiety I used to feel while preparing for them. I am sure this is the case for many of you as well. But remember, the NBEO part III exam is a milestone! The National Board of Examiners in Optometry (NBEO) serves to measure your clinical proficiency. You ARE proficient in your clinical skills!
All of those late nights of studying and those grueling hours of practicing in the clinical lab have led you to this. You have been preparing for the NBEO Part III exam for years, and you are ready! There is nothing on this exam that you do not already know.
The NBEO Part III Clinical Skills Examination (CSE) is a hands-on exam involving standardized patients. It is a measure of your physical optometry skills and practical clinical knowledge. The entire exam session is approximately 3.75 hours, which includes an orientation and a brief amount of time to practice using some of the testing center’s equipment. The exam is comprised of 4 stations. Each station focuses on a few specific clinical skills, outlined below. Before the timer begins for each station, you are given 4-5minutes to become familiar with the equipment and setup in each station’s exam room. There are 4 possible sequences of stations in which you may be asked to perform the exam, which are as follows:
  • 1 > 2 > 3 > 4
  • 2 > 3 > 4 > 1
  • 3 > 4 > 1 > 2
  • 4 > 1 > 2 > 3
To practice optometry in the United States you are required to pass the Part III CSE. Some states require higher scores for particular skills in order to be able to practice there. Other states require you to pass the ISE (Injections Skills Examination) in addition to the CSE. Be familiar with the clinical criteria required in the state in which you wish to practice.
On test day, remember to bring your OE tracker number, a valid photo ID, and a white coat if you have one. You may bring “reasonable items” into the exam, such as tissues, a snack, medications, an eye patch, or a bottle of water. Remember, during testing you will not refer to yourself by your name, but rather by your candidate ID (OE tracker number). You may refer to the standardized patients as Mr. or Ms. Lee if you wish to address them.
This article serves to provide helpful test day suggestions. However, the best way to become familiar with the structure and specific requirements of the NBEO part III exam is to read the candidate guide and evaluation forms on the NBEO website. The NBEO website also provides a very helpful orientation video.

Stations of the Clinical Skills Exam

Listed below is a basic guide of the skills tested within each of the four clinical stations. Small test day tips and strategies are provided. Linked within each station’s section is the evaluation form the examiners will be using to grade your performance.
It is helpful to tailor your practice sessions to the checklists on these forms so that you are rehearsed and familiar with what is expected of you for test day. The exam tests 19 total large scale “skills”, although each main skill is comprised of subsets of many small clinical procedures. You may repeat any clinical procedure as long as you are still within that larger skill.

Sign up to get tips for each station!

Keep reading for CSE tips and things to remember during the exam.

Practicing and Clinical Exam Tips:

When in doubt, wash your hands.

This is meant literally and figuratively. During some skills of the exam (namely the contact lens skills) it feels hard to remember all the times to wash your hands between skills. It is better to wash too much than too little.
Additionally, if you feel you did not perform well on a particular skill, that is okay! You can still pass the exam with some mistakes. Take a deep breath, wash your hands of it, and move onto the next skill. Many of us who thought we made a dire mistake during the test ended up doing better than we expected. Note that if you felt there was an equipment malfunction or some kind of event that negatively impacted your score, you have the opportunity to document an incident report immediately following the completion of all 4 stations. What comes of the incident report is at the discretion of the NBEO, but it will be reviewed.

State your findings and thought processes out loud

Verbalizing each exam procedure and finding while practicing makes it more of a habit for exam day. On exam day, this allows the examiner to see you understand the logic behind the skills, even if you make a mistake.

Practice on patients who are not students

While the standardized patients at the testing center have been trained and are experienced with the test procedures, they are not as knowledgeable or well rehearsed as your fellow optometry students. You also want to be prepared for a patient with a unique spectacle prescription or clinical findings during a slit lamp exam.

Use the NBEO Resources

The NBEO website provides excellent resources. Review the candidate guide and watch the orientation video. Have someone use the provided evaluation forms to assess your performance while you practice each station. Additionally, you are able to become familiar with the room setup and NBEO provided equipment via their website.
If you have the opportunity to practice with equipment similar to what will be provided to you on test day, it would be an excellent idea to practice with those items. If you do not, you will have the opportunity to practice with some of it on test day. Some of the equipment includes the BIO headset, retinoscopes, visual acuity chart with remote, exam chair, and ophthalmic lenses. Use the ophthalmic lenses you are most familiar with. Test day is not the time to experiment with a 78D lens if you are accustomed to using a 90D lens. Remember that you may bring your own retinoscope if you wish.

Five things to remember for exam day:

  1. Breathe! You got this! And if for some reason your exam does not go favorably, it is okay! You may take the test again. I promise you, none of your future patients will ask for your exam scores, and one test is not a reflection of the kind of provider you will be.
  2. Rest and eat well. Being anxious on test day is normal and to be expected, but try to get a good night’s sleep and eat at least something before your exam. You will be there for 4 hours, after all. You are able to bring a snack and water into the exam with you if you wish.
  3. Arrive early. I would recommend arriving in Charlotte the night before the exam if you do not live locally. Select local hotels have an affiliation with the NBEO and provide discounts for your stay. There are plenty of hotels within walking distance of the testing center. It is also beneficial to arrive at the testing center at least half an hour before your exam time. If you are not able to enter the actual testing center early, you may walk around the shopping area and restaurants on the third floor of the building. Exam day is stressful enough. You do not want tardiness to add to your stress.
  4. Allow ample time after the test before travel. The clinical exam is both emotionally and physically taxing. You do not want to be rushing to catch a flight or driving a long distance immediately after your exam. Give yourself some time to recover and maybe grab a bite to eat. You deserve it. There are also plenty of fun things to do in Charlotte if you have the ability to stay an extra night!
  5. The exam is not all or nothing. When your exam is being reviewed and graded, the examiners are checking each box on the evaluation sheet as yes or no, but there are so many boxes to be checked under each skill! You may make some mistakes on the exam: most of us do. When you leave, however, also focus on all of the things you did correctly during the exam. You are bound to have many more “yes” checkmarks than “no” checkmarks.
Preparing for the NBEO Part III exam can certainly feel overwhelming. Just practice one skill at a time—these are skills that you already have. You all have made it this far and you just have a few more tasks to complete before officially becoming an optometrist!
Best of luck to all NBEO Part III candidates!


National Board of Examiners in Optometry. National Center of Clinical Testing in Optometry. 200 S. College Street, #2020 Charlotte, NC 28202 [Updated 2020 Feb 7; Cited 2020 Feb 28].
Amrita Kaur, OD
About Amrita Kaur, OD

Dr. Amrita Kaur is an optometrist practicing in Pittsburgh, PA. She is a 2016 graduate of the Pennsylvania College of Optometry at Salus University. In the exam room she enjoys a challenging neuro or posterior segment case, pediatric exams, and getting to know her patients. Outside of the exam room, she enjoys drawing, playing tennis, and a good cup of tea!

Amrita Kaur, OD
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