The Part II PAM examination is administered in a computer-based testing (CBT) format. The NBEO has contracted with Pearson VUE for computerized testing services. Pearson VUE’s extensive network of more than 200 test centers provides relatively easy access for all candidates to sit for the exam. An interactive tutorial, designed to familiarize candidates with the features of the CBT format, can be downloaded here.
The PAM examination is administered in a single day. The December administration of PAM will be offered on two dates, but each candidate will take the exam on a single day. Different versions of the PAM exam will be given on each of the two days, but they will be equivalent in content and difficulty level. The April administration will continue to be offered on a single day.
The PAM exam is comprised of two sessions on a single day. Each session consists of approximately 175 items. The PAM exam is composed of Full Cases, Solo Items, and Minicases. Candidates are given 3 1/2 hours to complete each session. The morning session includes an additional 15 minutes (for a total time of 3 3/4hours) which is devoted to a tutorial (similar to the tutorial posted on this website) and the reading and signing of a non-disclosure agreement (NDA). There is an optional break of up to 45 minutes between the morning and afternoon sessions.
The earliest date for a student candidate to take the Part II examination is the December administration during the candidate's academic year of graduation at an accredited institution*, thereby allowing two opportunities to sit for the examination prior to graduation.
* Accredited by the Accreditation Council on Optometric Education (ACOE) of the American Optometric Association. Accredited Academic institutions include the 19 schools and colleges of optometry in the continental United States, the School of Optometry at Inter American University of Puerto Rico, and the two schools of optometry in Canada.
Registration and Scheduling
Candidates wishing to take the PAM or TMOD examinations must register and pay the exam fee using the NBEO’s online registration system. Upon completion of the NBEO online registration, candidates will receive 2 automatic emails.
1. Email from NBEO Confirming Registration
(Subject Line: “NBEO Exam Confirmation”)
Your registration was successfully received. After your registration is processed, you will be sent a second email providing the Pearson VUE instructions for selecting a test center. If you have questions, please contact our Registrar at 704-332-9565.
2. Email from NBEO with Instructions for Site Selection
(Subject Line: “Contact Pearson VUE ***Site Selection***”)
Once your registration is processed, you will receive a second email with instructions for contacting Pearson VUE to select your site. Candidates will select a single day to take the exam (the PAM exam is offered on two different days in December, but candidates will select one of the two days). Click here
for a list of Pearson VUE test center locations. Candidates may schedule the exam for any time slot that is available at their chosen site. PAM candidates will be scheduled for an 8-hour time slot.
If at any point you are unable to review your registration through the NBEO website, please visit http://www.pearsonvue.com/nbeo/ to confirm your registration and seat selection.
Be sure to check your spam/junk mail folders in case the emails are indirectly routed.
If you have questions, please contact our Registrar at 704-332-9565. If you need assistance with a site selection contact Pearson VUE customer service 800-359-3345.
The PAM examination will consist of 45-55 full cases, 15-20 solo items, and 15-25 minicases. The distribution of items by content area is indicated in the tables below.
|Disease/Trauma (60 – 70% of items)
|Lids / lashes / lacrimal system / ocular adnexa / orbit
||11 – 22
|Conjunctiva / cornea / refractive surgery
||33 – 44
|Lens / cataract / IOL / pre- and post-operative care
||17 – 28
|Episclera / sclera / uvea
||11 – 22
|Vitreous / retina
||33 – 44
|Optic nerve / neuro-ophthalmic pathways
||28 – 38
||16 – 27
||11 – 22
||11 – 22
|Refractive/Sensory/Oculomotor (30 - 40%)
||11 – 22
|| 6 – 17
||17 – 28
||6 – 17
|Accommodative / vergence / oculomotor anomalies
||20 – 25
|Amblyopia / strabismus
||6 – 17
|Perceptual function / color vision
||6 – 17
|Visual and human development
||0 – 6**
** Items pertaining to visual and human development may appear in cases in other categories.
The Examination Content Matrix, which contains the subject areas and their relative emphases, can be viewed by clicking here.
Items on 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 pathognomonic manner.
FULL PATIENT CASES begin 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 4-7 related multiple-choice items.
SOLO ITEMS are relatively straight forward, knowledge-centric, independent entities. They include a question and 3 - 7 answer options.
MINICASES are an abbreviated version of a full patient case. They consist of a shortened scenario with 2 - 4 related questions. Most minicases will also include one or more associated images.
See the Sample Test Items page for more information about MR items.
The table below describes the types of items that will appear on the PAM examination.
|Type of Test Item
||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
|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
||epidemiology, biostatistics and measurement, environmental vision, health care policy and administration
Description of PAM Item Types
Patient Cases are the most clinically sophisticated item type within the PAM exam. They include a lengthy, comprehensive scenario of simulated patient data, multiple supportive photos, and 4-7 items per case, each with 3-10 answer options. Click here to view 4 sample PAM patient cases.
- There are 45-55 patient cases on the exam.
- The patient case section of the Pearson VUE PAM exam appears on a standard white background.
- The scenario is found on the left side of the Pearson VUE computer screen. The case images appear at the bottom of the left side of the screen, beneath the scenario. The 4-7 items are presented one at a time, on the right side of the screen. Candidates are able to view the scenario/images on the left side of the screen at the same time that they work with a case item on the right side.
- Patient case images typically provide a considerable amount of essential patient information. Photos may supply normal or abnormal case details; candidates are expected to correctly interpret the visually presented findings. Images may include, but are not limited to, color photographs and such testing results as VFs, FAs, OCTs, ultrasonography, radiologic imaging, etc.
- Case items may be multiple-choice, with a single correct answer, or they may be multiple-response, with up to 4 correct answers. It is necessary to select all of the correct answers, and only the correct answers, in a multiple-response question to receive credit.
Solo items are relatively straightforward, knowledge-centric, independent entities. They include a question and 3-7 answer options. Click here to view 3 sample PAM solo items.
- The PAM exam contains 15-20 solo items.
- The solo item section of the Pearson VUE PAM exam appears on a pale blue background to help distinguish this section from the patient case and mini case sections.
- Solo items may be multiple choice, with a single correct answer, or they may be multiple response, with up to 4 correct answers. It is necessary to select all of the correct answers, and only the correct answers, in a multiple-response question to receive credit.
- The 15-20 solo items are presented on the Pearson VUE test center computer screens one at a time.
Minicases are more complex than solo items, but not as detailed as patient cases. They each consist of an abbreviated scenario and 2-4 related questions. Click here to view 2 sample PAM mini cases.
- The PAM exam contains 15-25 mini cases.
- The mini case section of the Pearson VUE PAM exam appears on a pale orange background to help distinguish this section from the patient case and solo item sections.
- On the left side of the Pearson VUE mini case computer screen, the abbreviated scenario is presented while on the right side of the screen; one of the 2-4 associated items is shown one at a time.
- Mini case items may be multiple-choice, with a single correct answer, or they may be multiple-response, with up to 4 correct answers. It is necessary to select all of the correct answers, and only the correct answers, in a multiple-response question to receive credit.
Imbedded TMOD Examination
The question portion (stem) of each multiple-response item indicates to the candidate how many of the options should be selected. For example, when an item stem asks, “Which 3 of the following …,” the stem concludes with the phrase (Select 3) to make it unmistakable to examinees that this is a multiple response item that requires 3 correct responses.
Approximately 100 – 120 of the 350 items in the PAM examination 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 may include additional clinical findings or in the instance of minicases, fewer 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 since it is implied via the BVA terminology that this has already been done.
Candidates should assume that VA at near was tested at 16 inches unless otherwise noted.
"Review of systems" entries are current symptoms reported by the patient. The patient’s current medical conditions and diagnoses are recorded as “Patient medical history” entries.
All patients with diabetes mellitus will have an HgbA1c value as part of the medical history. Interpretation of HgbA1c values is considered an entry level skill; therefore additional interpretation and/or normal ranges will not be given.
Some patient cases in the PAM exam may include normal clinical photos and/or visuals. It is anticipated that candidates will review and appropriately interpret the visuals included in the patient cases.
When visual field images are displayed side-by-side, with the right visual field on the right and the left visual field on the left, the image numbers will appear to be out of sequence (see Sample Case 4 as an example). This occurs because images are numbered sequentially as referenced in the case scenario, and the OD is always referenced before the OS in the clinical findings section. In some instances, it is necessary to display the visual fields vertically; in these instances the right visual field will be on top followed by the left visual field below.
Candidates should assume that all items in the case refer specifically to the patient depicted in the scenario. If the item is not referencing the depicted patient, it will be stated clearly in the item stem. For example: “Which of the following is the mostly likely cause of this condition in the general population?” or “In the majority of patients complaining of these symptoms ...”
To reduce the verbiage within cases and test items, individual drugs included on PAM are referenced by generic or trade name, but not both. During the exam, candidates have access to a searchable drug list. You may search for a drug by it’s trade name or generic name. These lists may be accessed from any page of the exam by clicking on the Exhibits button at the top of the screen. Candidates should note that the list will include drugs used on other National Board exams; therefore, significantly more drugs will appear on the list than actually appear on the PAM exam.
In addition, commonly utilized abbreviations included in the PAM patient cases can be found on the abbreviations list. A copy of the PAM Examination Abbreviations List may be accessed from any page of the exam by clicking on the Exhibits button at the top of the screen.