(Updated September 21, 2009)

The Part II examination, entitled “Patient Assessment and Management” (PAM), is an expanded version of the PAM examination that was previously a section of Part III. Beginning December 2009, PAM will comprise all of new Part II and will no longer be a component of Part III.

The existing student eligibility requirements will remain the same for new Part II; that is, being midway through the fourth academic year. Therefore, the targeted administration (i.e., the administration that most students take when they become eligible) will remain in December. There will continue to be two opportunities to take Part II prior to graduation, as there will be an additional administration in April.

The PAM examination will consist of 60 simulated patient cases and is administered over two sessions, each 3 ½ hours in length. The distribution of cases by content area is indicated in the outline below.

Disease/Trauma (60% - 70% of cases):

• Lids / lashes / lacrimal system / ocular adnexa / orbit  (2 – 4 cases)
• Conjunctiva / cornea / refractive surgery  (6 – 8 cases)
• Lens / cataract / IOL / pre- and post-operative care  (3 – 5 cases)
• Episclera / sclera / uvea (2 – 4 cases)
• Vitreous / retina (6 – 8 cases)
• Optic nerve / neuro-ophthalmic pathways  (5 – 7 cases)
• Glaucoma  (2 – 4 cases)
• Emergencies  (2 – 4 cases)
• Systemic health  (2 – 4 cases)

Refractive Status/Sensory Processes/Oculomotor Processes (30% – 40% of cases):

• Ametropia  (3 – 5 cases)
• Ophthalmic optics  (1 – 3 cases)
• Contact lenses  (3 – 5 cases)
• Low vision  (1 – 3 cases)
• Accommodative / vergence / oculomotor anomalies  (2 – 4 cases)
• Amblyopia / strabismus  (1 – 3 cases)
• Perceptual function / color vision  (1 – 3 cases)
• Visual and human development  (1 – 3 cases)

Patient cases for the PAM examination are targeted to assess entry-level competence. Therefore, patient cases generally focus on either typical presentations of relatively high-frequency conditions or conditions with low-frequency but high-criticality. When low-frequency, high-criticality cases are presented, they will be portrayed in a classic, straightforward manner.

Each patient case begins with a scenario in which the patient history and clinical data are presented. These data usually include at least one visual (e.g., color ophthalmic photographs; contact lens fluorescein pattern; spectacle frame fitting problem; visual field plots; other instrumentation printouts). The scenarios are followed by either 5 or 6 related multiple-choice test items, for a total of 350 items. Each test item contains as many as 10 options, only one of which is correct. The table below describes the types of items that will appear on the PAM examination.

Type of Test Item	Content
Diagnosis	most appropriate diagnosis
Related to Diagnosis	indicate data supporting or correlating with diagnosis; correlation of possible additional data; or,indicate additional data or next test needed
Treatment / Management	most appropriate treatment / management
Related to Treatment / Management	treatment mechanism; additional data needed to treat effectively; additional next test needed; additional data or next test needed; patient education; follow-up; or, prognosis
Clinical Correlation of Basic Science Principles	pathophysiology / etiology, anatomy, biochemistry, physiology, immunology / microbiology / pathology, optics, pharmacology
Legal Issues / Ethics	licensure and governmental regulation of optometry, standards of professional ethics, doctor-patient relationship, professional liability
Public Health	epidemiology, biostatistics and measurement, environmental vision, health care policy and administration

In addition, 100 – 120 items are categorized as TMOD (Treatment and Management of Ocular Disease) items. A TMOD breakout score and pass-fail decision will be determined based on these items, and reported for state boards requirements. In order to be classified as a TMOD item, the content of the item must pertain to one or more of the following:

• Formulation of most appropriate disease diagnosis which will be treated and/or managed
• Clinical correlation of basic science principles related to disease diagnosis and treatment
• Selection of treatment/management, including systemic considerations
• Dose, form, schedule, and duration of treatment
• Contraindications and side effects of medication, including systemic considerations
• Follow-up and prognosis, including reassessment of diagnosis after initiating treatment
• Treatment and management of ocular emergencies and urgencies

Two blank PAM Patient Scenario Templates, one for Disease/Trauma cases and one for Refraction/Sensory/Oculomotor Conditions cases, are available as exam preparation resources. These templates should be viewed as examples, since some patient cases on the exam may include additional clinical findings. In multiple cases on the exam, "BVA" data are included in the patient scenarios. The abbreviation "BVA" refers to "best visual acuity" or "best-corrected visual acuity" measurement, which may be accomplished by refraction, pinhole testing, etc. Thus, all BVA entries refer to the best achievable visual acuity by the patient depicted in the scenario. If the BVA is reduced (e.g., worse than 20/20), no pinhole entry will be included in the BVA clinical data entry since it is implied via the BVA terminology that this has already been done. In addition, some patient cases in the PAM exam may include normal clinical photos and/or visuals. Thus, it is anticipated that Candidates will review and appropriately interpret the visuals included in the patient cases.

To reduce the verbiage within test items, individual drugs included on PAM are referenced by generic or trade name, but not both. The PAM examination booklet will include two lists of generic drugs and their trade name equivalents. The first list alphabetizes the drugs by their trade names, and that list is printed on the inside front cover of the test booklet. The second list alphabetizes the drugs by their generic names, and that list is printed on the inside back cover. These lists do not include every drug used on PAM; rather, they include those drugs on the test that have commonly utilized trade names. These two lists may be used as resources throughout the test.

In addition, and similar to clinical care notation, commonly utilized abbreviations are included in the PAM patient cases consistent with a prepared abbreviations list. A copy of the PAM Examination Abbreviations List is included in the examination booklet and may be used as a resource throughout the test.

The Examination Content Matrix, which contains the subject areas and their relative emphases, can be viewed by clicking here.

There are 4 sample PAM patient cases available on the web site. These cases illustrate typical scenarios for both Refractive and Disease cases and include examples of the various types of items that will appear on the examination.