Exam Administration

Beginning with the April 2012 administration, the Part II – PAM examination will be 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 will be posted on this web site in February 2012, allowing candidates to become familiar with the features of the CBT format.

The PAM examination is administered in a single day, over 2 sessions. Each session consists of 30 patient cases with 175 items. Candidates are given 3 ½ hours to complete each session. The morning session includes an additional 15 minutes (for a total time of 3 ¾ hours) which is devoted to a tutorial (identical to the tutorial posted on this web site) and the reading and signing of a non-disclosure agreement (NDA). Ability to view NDA coming soon... There is an optional break of up to 45 minutes between the morning and afternoon sessions.

Eligibility

Students are first eligible to take the PAM examination midway through the fourth academic year. The targeted administration of PAM (i.e., the administration that most students take when they become eligible) is in December. An additional administration in April provides students with a second opportunity to take Part II prior to graduation.

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. Click here to begin the registration process. Upon completion of the NBEO online registration, candidates will receive an automatic email with the following message:

Once eligibility is verified, the candidate will receive another email with instructions for contacting Pearson VUE to schedule the exam. The exams are available on a single day only. You may schedule your exam for any time slot that is available on the day, at that site. Click here for a list of Pearson VUE test center locations. The PAM exam requires an 8-hour time slot; the TMOD exam requires a 4-hour time slot.

Exam Content

The PAM examination will consist of 60 simulated patient cases. 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  (3 – 5 cases)
• Emergencies  (2 – 4 cases)
• Systemic health  (2 – 4 cases)

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

• Ametropia  (2 – 4 cases)
• Ophthalmic optics  (1 – 3 cases)
• Contact lenses  (3 – 5 cases)
• Low vision  (1 – 3 cases)
• Accommodative / vergence / oculomotor anomalies  (5 – 7 cases)
• Amblyopia / strabismus  (1 – 3 cases)
• Perceptual function / color vision  (1 – 3 cases)
• Visual and human development  (0 – 1 cases)*

* Items pertaining to visual and human development will 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.

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 pathognomonic 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. The large majority of items are traditional multiple-choice items with a single correct answer. Approximately 10 – 15% of the items are multiple-response (MR) items, with more than one correct answer. 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	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

Imbedded TMOD Examination

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

Additional Information

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.

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 included with a case, the images will typically be displayed side-by-side, with the right visual field on the right and the left visual field on the left. In these cases, 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 of the scenario. 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 on the bottom.

Candidates should assume that all items in the case refer specifically to the patient depicted in the case. 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 two lists of drugs, one that alphabetizes the drugs by their trade names and one that alphabetizes the drugs by their generic names. 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 lists include only those drugs that have commonly used trade names. Drugs such as tetracycline and homatropine will not appear on the list. Candidates should also 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. Candidates can see the drug lists used on a recent PAM exam by clicking here.

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 may be accessed from any page of the exam by clicking on the Exhibits button at the top of the screen.

There are 4 sample PAM patient cases available on the web site.

Revised 01/23/2012