Oral Board Exam:  Content Overview

In this section, I plan to dive into the subject material a little bit, and discuss the format for presentation.  The oral board exam is organized much differently than the OKAP or WQE, but it's my personal opinion that the oral exam isn't aiming to test new knowledge, but trying to see if you can succinctly and accurately synthesize all of the raw information you were able to regurgitate on the written exams.  As such, the approach I am outlining for studying for the oral board exam is built on that philosophy, and hopefully it will help you refine your own study approach.

My disclaimer, of course, is that I am not involved in any way with the American Board of Ophthalmology or any of the board examinations.  Even if I were, I cannot and would not be able to disclose any inside information about the tests.  The opinions and statements regarding the tests are mine, and are not a reflection of the ABO or AAO.  Additionally, because the subject matter lists are finite and logically I will be discussing common diseases in ophthalmology, any similarities to actual test questions are coincidental - I did not and have not reproduced or attempted to recall any actual test questions.

Oral Board Exam Topics

As noted on the ABO website, the oral board exam is divided into 6 topics:

  1. Anterior Segment of the Eye
  2. External Eye and Adnexa
  3. Neuro-Ophthalmology and Orbit
  4. Optics, Visual Physiology and Correction of Refractive Errors
  5. Pediatric Ophthalmology and Strabismus
  6. Posterior Segment of the Eye

At the oral board exam, you will be moving between 6 rooms, spending 25 minutes in each room to discuss cases pertaining to one of those 6 topics.  Because the cases will be divided into those specific sections, I would suggest organizing your studying in a way that mirrors that classification.  Keep in mind that this type of organization does not exactly correlate with the AAO's Basic and Clinical Science Course material, and as such each section may only deal with part of one book.

Here is a little table to help you consider the division of topics if you decide to use the BCSC series to study (I don't remember if cornea is classified as anterior segment or external eye for the oral boards):

Exam TopicBCSC Section(s)Topics Within The Book

Anterior Segment of the EyeSection 10:  GlaucomaEverything

Section 11:  Lens and CataractEverything

External Eye and AdnexaSection 7:  Orbits, Eyelids, and Lacrimal SystemEyelids and lacrimal system

Section 8:  External Disease and CorneaEverything

Neuro-Ophthalmology and OrbitSection 5:  Neuro-OphthalmologyEverything

Section 7:  Orbits, Eyelids, and Lacrimal SystemOrbits

Optics, Visual Physiology, and Correction of Refractive ErrorsSection 3:  Clinical OpticsEverything

Section 13:  Refractive SurgeryEverything

Pediatric Ophthalmology and StrabismusSection 6:  Pediatric Ophthalmology and StrabismusEverything

Posterior Segment of the EyeSection 9:  Intraocular Inflammation and UveitisEverything

Section 12:  Retina and VitreousEverything

The Oral Exam Presentation

Honestly, I don't know if there is a "right" way to take the oral board exam.  There is a general format, which seems to be generally taught, in how to approach the oral presentation.  The ABO has a very nice video that gives examples of how an examiner may lead you through the test.  However, there are also many examiners that may not provide any verbal prompts as you work through the pictures or videos that are used in the exam.  Just remember that the goal is to go through as many cases as possible in 25 minutes, and if you don't practice your cadence, you may spend most of your time on just a handful of prompts...which may in turn decrease your chances of passing.

As a simple summary, these are the principles I think you can take away from the sample video, and how to practice for the actual exam:

  1. Get to the point early and quickly.  The images and videos are not meant to be tricky.  Go ahead and say what you think it is.  You can describe it if the differential is large, such as "I see optic nerve elevation with blurred margins, multiple flame hemorrhages, and surrounding retinal edema."  But my personal impression is that identifying the disease should not be the rate-limiting step.
  2. Focus your history and physical.  While many oral board exam prep resources recommend discussing a very thorough history and physical, the video seems to indicate otherwise.  Because you don't have much time per case, make sure to identify the key terms in the history and exam that are essential to the condition.
  3. Be prepared to list the components of the question stem or the image/video that justifies your diagnosis.  Some examiners may ask this of you; others may wait for you to produce this rationale on your own.  Because you will be tested on how well you are able to articulate your clinical reasoning, you should practice being able to explain your rationale quickly and succinctly.
  4. It helps to have an appropriately organized differential diagnosis already considered for any given condition.  I don't know that many of us intentionally consider how we determine our differential diagnoses, but I've found these rules of thumb to be helpful, especially when preparing your responses:
    1. What you think the condition most likely is should be your first response.
    2. Next should be other conditions in the differential, in order of most common to least common.
    3. Be sure to include life-threatening, eye-threatening, and sight-threatening conditions as priority diagnoses within that list.
    4. Rare conditions should only be mentioned if they are life-threatening, eye-threatening, or sight-threatening.
  5. List only workup pertinent to your most likely diagnosis.  It's pretty easy to go on and on discussing how you might order genetic tests for optic atrophy even though the presentation is much more suspicious for an optic nerve sheath meningioma.  Don't spend time expanding the workup; the examiner may ask if there is anything else to test for, as shown on the video.
  6. Management should also be approached systematically.  For example, there are tons of different procedures available for treating congenital nasolacrimal duct obstruction; however, depending on the age of the child, duration of symptoms, etc., conservative measures would likely be the first-line treatment.  As such, here are some rules of thumb I follow to consider organizing your management approach.
    1. Know the most common treatments.
    2. As with workup, typically least invasive to most invasive is appropriate.
    3. However, the main exception is with true emergency conditions.  Knowing when urgent or emergent intervention is appropriate is an important part of the test.
    4. You probably don't need to discuss the latest experimental treatment, but you do need to be able to list the common options for treatment.
    5. You can be somewhat generic about treatment, such as "aqueous suppressant" or "topical steroids" without having to say actual medications or other sorts of treatments.
  7. Each case should take only a few minutes to complete.  Some cases may have more information than others, but the more you can get through the better your chances of passing that section.

Do you have any other tips for studying for the oral board exam?  Do you have suggestions for other topics?  Contact us!