Ophthalmology Boards Fail Rate

[DrQuakerJack]

I compiled the pass/fail rate among some specialties where the data is made publicly available. I was unable to find dermatology and ENT. Also, note that the internal medicine and neurology data is for first-time test takers only.

Board		Year		# of Written Board Examinees	Written Board Fail Rate		# of Oral Board Examinees	Oral Board Fail Rate
Ophthalmology		2018		658	22%		673	15%
Urology		2018		315	1%		302	8%
OB/GYN		2018		1517	17%		No exam data available
Surgery		2019		1449	5%		1437	21%
Internal Medicine		2017		8262	10%
Pediatrics		2019		3385	13%
Neurology		2017		1501	11%

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[pachyworthia]

American Board of Ophthalmology Facts & Statistics | American Board of Ophthalmology

Certification Written Qualifying Examination (WQE): Year Total Candidates Passed Pass % Failed Fail % 2011 636 456 71.70 180 28.30 2010 628 ...

abop.org

Interesting to note the differences between written and oral boards pass rates for first-time and repeat test takers. For written boards, the pass rate is high for first-time test takers (90-95%) and low for repeat takers (35-40%). For oral boards, the pass rate is 75-85% for first-time test takers and just a touch lower for repeat takers (65-75%).

So far this year's oral boards pass rate has been among the lowest since the 2016S administration when it was 72.5%.

 

[Slide]

American Board of Ophthalmology Facts & Statistics | American Board of Ophthalmology

Certification Written Qualifying Examination (WQE): Year Total Candidates Passed Pass % Failed Fail % 2011 636 456 71.70 180 28.30 2010 628 ...

abop.org

Interesting to note the differences between written and oral boards pass rates for first-time and repeat test takers. For written boards, the pass rate is high for first-time test takers (90-95%) and low for repeat takers (35-40%). For oral boards, the pass rate is 75-85% for first-time test takers and just a touch lower for repeat takers (65-75%).

So far this year's oral boards pass rate has been among the lowest since the 2016S administration when it was 72.5%.

The repeat pass rate is higher for the oral boards because of the format and some aspect of false confidence from test takers. The oral board format is unlike any other medical test you will take. My thoughts are that a good portion that fail are unfamiliar with what needs to be done, or due to lack of preparation. If someone has the knowledge to pass the written, then knowledge isn’t the issue for orals.

Still, I really do not like how high the failure rates are for our boards in general. Yes there are bad programs out there, but not enough to reflect the failure rates listed.

 

[Gonio5]

I suspect that there has been some sort of change recently.

Pre-2015, the written pass rate was significantly lower. The failure rate among first takers was 15-20%, always in the 80's passing except 2013, when it was 90% for first takers. Overall, including repeaters, the failure rate pre-2015 was 22.6%-30.73%.

When there has been a change in format, the pass rate dropped a lot. When the orals changed from paper books to iPads, the failure rate rose from the mid-teens to 28.8%. When the orals changed from in-person to virtual, the failure rate rose from 14.3-22.9% to 22.6-26.9%. Why? My guesses are that most candidates are secretive and scared so that they do not disclose what was asked. However, faculty members, particularly those in residency programs that have many examiners, do give hints particularly on the format according to rumor. When the format changed, more people failed the first time there was a change in format.

I also suspect that the virtual orals are somehow more difficult than the in-person orals. It might be delay with bandwidth or maybe hearing the candidates responses or something. The ABO knows that there is something to change so they changed it from 10 cases in 25 minutes to 14 cases in 50 minutes. The increase to 50 minutes is understandable because it's more complicated to change "rooms" online. But cutting the number of cases has to have a reason. The ABO should share it but I suspect it might not be too flattering so it is not shared.

The change from 2.5 minutes per case to 3.57 minutes per case is probably good. It does probably result in a few more failures because getting stuck on 2 cases per 25 minutes represents 20% of the cases in the old format but getting stuck on 2 cases per 25 minutes represents 29% of the cases in the virtual format. The increase of time per case more closely aligns with the Canadian RCS exam in that the Canadians tend to want more detail at the expense of few questions.

Another change in the virtual orals is that since 2 "rooms" are combined, there are now 2 examiners. Having two examiners means that examiners are discouraged from being abusive a-holes but also from being too helpful because they cannot act alone in secret. I have heard of folklore that occasionally an examiner is too helpful, accepting what the candidate thought was too incomplete an answer but then allowing the candidate to finish all cases ahead of time. (If the examiner was not too helpful, they would force the candidate to answer the question more fully, like to give a differential or better history).

All this is probably too much analysis but we, ophthalmologists, are known to be more detail oriented than many other specialties.

I am taking the orals in 4 weeks and would welcome any discussion, public or private DM, with any diplomate or candidate preparing to discuss my analysis of how to approach an oral question or any other oral topic. I am developing a way but don't know if it will work or not.

 

[optamologistz]

Still, I really do not like how high the failure rates are for our boards in general. Yes there are bad programs out there, but not enough to reflect the failure rates listed.
[/QUOTE]

Does being at a bad program really reflect the knowledge tested on the written? In my experience, what is tested has minimal clinical relevance to an extent, and is more academic based. Therefore, you could be at a good or bad program, and still be unprepared. Most ophthalmology residents achieved residency through impressive Step scores, hence good test takers. So yea, the failure rates seem pretty high for how driven the group is as a whole.

 

[DrZeke]

Still, I really do not like how high the failure rates are for our boards in general. Yes there are bad programs out there, but not enough to reflect the failure rates listed.

Does being at a bad program really reflect the knowledge tested on the written? In my experience, what is tested has minimal clinical relevance to an extent, and is more academic based. Therefore, you could be at a good or bad program, and still be unprepared. Most ophthalmology residents achieved residency through impressive Step scores, hence good test takers. So yea, the failure rates seem pretty high for how driven the group is as a whole.
[/QUOTE]

I think it matters. Board pass rates are lower at bad programs. If you are not immersed in an environment that teaches you how to think about each patient or case properly then it requires more work to do better or to even pass. If you have less experience with subspecialties, certain topics can be daunting. If your didactics were poor, if BCSC reading wasn't enforced, if lectures sucked...

Yes you have to do a certain amount of work to do well on the boards, but for most of us that aren't on either end of the bell curve, you put in what you get out. If there was no available structure in your residency that reinforced a strong background for boards, then you have to put in more when the time comes to study.

Also, at some "bad" or "less strong" programs, call is light, and hours are light. In fellowship or job, might not be so lucky. I found myself working very very hard in fellowship and so I had to buckle down and take a few hours here and there to devote consistently to studying for boards in the months leading up to the test. I planned...

 

[DrQuakerJack]

I feel very strongly that they should be able to provide a checklist of what they expect the candidate to say on each case presentation. Instead, they leave the criteria open-ended, so the entire grading becomes 100% subjective based on the examiner's views.

Example Scoring Rubric

Why not have 10 bullet points the candidate must hit for each case? Make this objective. You could even have a couple bullet points be an automatic fail for that case (ie. missing GCA or a carotid dissection).

I know ophthalmology residents are smart people who take studying for the boards seriously, so with a 25% first-time fail rate, either the programs or the Board are failing the candidates. There is no other way around it.

Like all things in medicine, I can't help to think that $$$ plays a role in all this.

 

[Dusn]

I agree that I think the boards charges too much and the fact that they allowed older ophthalmologists be grandfathered in, delegitimization them.

But I also train residents and I find the clinical knowledge of a fair percent of them (and to be frank, some attendings as well) to be lower than I would expect. I think this is multifactorial — they are ultra-focused on their cataract surgery numbers and research to get into fellowships, and attendings staff them in the OR but provide very little teaching in the clinic. The majority of cases of preventable blindness that I’ve seen stems from missing something in clinic, not poor surgical skill. Even the majority of poor surgical outcomes seem to be from missing a diagnosis in pre-op clinic, poor post-op management, or taking out a cataract when the cataract wasn’t causing the patient‘s vision complaint in the first place.

So I agree that the ongoing cost of the boards may be too high and some of their requirements (especially post-boards) are tedious but I would argue that the board exam is not difficult and nobody should be have been allowed to be “grandfathered.” I also agree with making sure the oral boards are standardized and objective.

 

[hello lady!]

The concern with the board fail rate and lack of objectivity usually correlate to the level of anxiety one has when preparing to take them. I walked out of the oral boards thinking it was an extremely fair test.

 

[hello lady!]

I feel very strongly that they should be able to provide a checklist of what they expect the candidate to say on each case presentation. Instead, they leave the criteria open-ended, so the entire grading becomes 100% subjective based on the examiner's views.

Example Scoring Rubric

Why not have 10 bullet points the candidate must hit for each case? Make this objective. You could even have a couple bullet points be an automatic fail for that case (ie. missing GCA or a carotid dissection).

I know ophthalmology residents are smart people who take studying for the boards seriously, so with a 25% first-time fail rate, either the programs or the Board are failing the candidates. There is no other way around it.

Like all things in medicine, I can't help to think that $$$ plays a role in all this.

I think the board examiners are highly trained and their gradings are fairly consistent. I 100% agree with your bold statement - I would vote that it's the programs failing the candidates (and also the candidates failing themselves).

 

[Dusn]

I will add that a strong correlation with failing the boards is having a baby a few months before the test. Anecdotally this might be one of the strongest correlations I know. This has happened to several residents and I know it happens in other specialties as well. The first year after having a kid is going to be sleep deprived and rough. I would definitely not recommend delaying having a kid though. If you fail the exam, in the grand scheme of things it’s not a big deal. You can retake the exam.

 

[Bronze Medal]

I will add that a strong correlation with failing the boards is having a baby a few months before the test. Anecdotally this might be one of the strongest correlations I know. This has happened to several residents and I know it happens in other specialties as well. The first year after having a kid is going to be sleep deprived and rough. I would definitely not recommend delaying having a kid though. If you fail the exam, in the grand scheme of things it’s not a big deal. You can retake the exam.

Since we are sharing anecdotes I’ll say that taking oral boards while pregnant strongly correlates with passing. Speaking from my own personal experience and that of my friends.

 

[LightBox]

I think a healthy failure rate is probably healthy for the profession. We should limit our supply of ophthos akin to how Derm limits their numbers. Otherwise we cannibalize each other with oversupply.

 

[DrQuakerJack]

I think a healthy failure rate is probably healthy for the profession. We should limit our supply of ophthos akin to how Derm limits their numbers. Otherwise we cannibalize each other with oversupply.

yeah, that way we can make the system even more unnecessarily punitive than already it is.

 

[LightBox]

Too many participation trophies given out as it is already in today's world.

 

[orbitsurgMD]

I agree that I think the boards charges too much and the fact that they allowed older ophthalmologists be grandfathered in, delegitimization them.

But I also train residents and I find the clinical knowledge of a fair percent of them (and to be frank, some attendings as well) to be lower than I would expect. I think this is multifactorial — they are ultra-focused on their cataract surgery numbers and research to get into fellowships, and attendings staff them in the OR but provide very little teaching in the clinic. The majority of cases of preventable blindness that I’ve seen stems from missing something in clinic, not poor surgical skill. Even the majority of poor surgical outcomes seem to be from missing a diagnosis in pre-op clinic, poor post-op management, or taking out a cataract when the cataract wasn’t causing the patient‘s vision complaint in the first place.

So I agree that the ongoing cost of the boards may be too high and some of their requirements (especially post-boards) are tedious but I would argue that the board exam is not difficult and nobody should be have been allowed to be “grandfathered.” I also agree with making sure the oral boards are standardized and objective.

That was controversial but apparently an issue they couldn't contractually change. The board issued lifetime certifications for the consideration of their fees (and having passed their tests) and they had to deliver. They could and did change the requirements for new candidates but they couldn't rescind the certifications made under the old system. Those folks weren't "grandfathered" as was the case say for Emergency Medicine (where before proper residencies were established with ACGME recognition, people with two years of IM, FP or surgery could sit for the test and if passed, become board-certified in EM without having done an EM residency.) They were board-certified by the ABO by the only pathway available.

I wouldn't say the change de-legitimized the ABO. To be an ABO examiner, you have to participate in and pass the MOC process just the same as those who take the current initial ABO exam series do, which is all they can require. What impeaches the ABO is the fact that only the new diplomates have to participate in the MOC and of course, pay for it. The rates they charge, and the salaries they pay their executives are what legitimately leave them open to criticism. When the same organization both establishes the requirements for and exclusively supplies the necessary materials to maintain certification, they have a conflict of interest.

 

[Gonio5]

I feel very strongly that they should be able to provide a checklist of what they expect the candidate to say on each case presentation. Instead, they leave the criteria open-ended, so the entire grading becomes 100% subjective based on the examiner's views.

Last year, an ABO board member gave a speech where he gave a sample correct answer to that link that you provide. It was not a secret speech. Anyone could attend. Playing the sample examiner was another ABO board member.

 

[Gonio5]

I feel very strongly that they should be able to provide a checklist of what they expect the candidate to say on each case presentation. Instead, they leave the criteria open-ended, so the entire grading becomes 100% subjective based on the examiner's views.
...

I know ophthalmology residents are smart people who take studying for the boards seriously, so with a 25% first-time fail rate, either the programs or the Board are failing the candidates. There is no other way around it.

If the orals were slightly different, the pass rate could be higher, in my opinion. If they showed all the questions in the room, gave you a sheet of paper, some time to write notes, didn't let you leave the room then started the exam, more people would pass. The time to briefly take notes to organize thoughts would make a big difference.

Consider 2 candidates. They both know the same. However, one is more attractive looking and can talk smoothly. Another candidate stammers, is not completely organized, and forgets stuff is going to have a higher chance of failure. However, if that second candidate (and all candidates) are allowed a brief few moments to think and to jot down some notes after seeing the questions would equalize the situation.

What if you talk about history then exam then remember an important history question. That looks terrible.

 

[hello lady!]

I will add that a strong correlation with failing the boards is having a baby a few months before the test. Anecdotally this might be one of the strongest correlations I know. This has happened to several residents and I know it happens in other specialties as well. The first year after having a kid is going to be sleep deprived and rough. I would definitely not recommend delaying having a kid though. If you fail the exam, in the grand scheme of things it’s not a big deal. You can retake the exam.

I could see having a 4-10 year old be a challenge to studying but having a baby is actually not that bad. I propped my little one up and he just watched me study - he had nothing better to do. I wouldnt advise bringing them to the hotel room the night before the test, though.

 

[hello lady!]

If the orals were slightly different, the pass rate could be higher, in my opinion. If they showed all the questions in the room, gave you a sheet of paper, some time to write notes, didn't let you leave the room then started the exam, more people would pass. The time to briefly take notes to organize thoughts would make a big difference.

Consider 2 candidates. They both know the same. However, one is more attractive looking and can talk smoothly. Another candidate stammers, is not completely organized, and forgets stuff is going to have a higher chance of failure. However, if that second candidate (and all candidates) are allowed a brief few moments to think and to jot down some notes after seeing the questions would equalize the situation.

What if you talk about history then exam then remember an important history question. That looks terrible.

I think that's disingenuous to attribute people's success to their attractiveness. There's no reason you can't go back and ask for an additional history/physical exam piece as you're formulating your differential diagnosis.

"Consider two candidates who have the same knowledge but one forgets stuff" lol come on, why does this person need equalization? They need to not forget stuff.

 

[LNVRO24]

For those that fail oral boards this fall, when is the next chance to test? A spring virtual exam?

 

[Gonio5]

For those that fail oral boards this fall, when is the next chance to test? A spring virtual exam?

No date has been announced. Originally, it was in person orals for March 2020 and March 2021.

I think that's disingenuous to attribute people's success to their attractiveness. There's no reason you can't go back and ask for an additional history/physical exam piece as you're formulating your differential diagnosis.

I believe it is denial to reject bias to to attractiveness. As I look at my medical school class, the ugly women and short men tend to go into family medicine and the better looking medical students went into ophthalmology, ENT. orthopedics. One medical student told me that she felt she was favored due to her gender and appearance, given more attention and given more informal teaching during the 3rd and 4th years. One chairman said that he purposely selects women because there's a greater chance of women working part time and he wants fewer ophthalmologists. Don't worry, that chairman is no longer chair. Ugly people like me can try to compensate, though, by wearing sharp business attire and preparing for the orals. Those things, I'll do.

 

[TheLesPaul]

I think a healthy failure rate is probably healthy for the profession. We should limit our supply of ophthos akin to how Derm limits their numbers. Otherwise we cannibalize each other with oversupply.

This is such an incredibly toxic opinion and reeks of the "I got mine so screw you" so typical of the boomers who have screwed up the world for future generations. The limit should be at the ophthalmology match, not after a fully trained and competent surgeon (and yes -- they are competent, they passed residency satisfactorily) passes a test which the older generation did not have to.

 

[LightBox]

This is such an incredibly toxic opinion and reeks of the "I got mine so screw you" so typical of the boomers who have screwed up the world for future generations. The limit should be at the ophthalmology match, not after a fully trained and competent surgeon (and yes -- they are competent, they passed residency satisfactorily) passes a test which the older generation did not have to.

I'm just sick of the constant whining. Study hard, practice with a partner, get one of the Oral board prep courses (e.g. OQ) and you will pass this thing.

There is definitely bias toward attractive people (especially women). There are many dirty old men in power positions who like to be surrounded by non-ugly women. Even if it is not this blatant, there is an implicit bias that human evolution has created over the millennia. If the powers-in-charge really wanted to get rid of this bias, then get rid of face-to-face interviews altogether.

 

[TheLesPaul]

I don't think anyone is arguing that the test can be passed with study. The problem is, it is an expensive, time-consuming, and wholly unnecessary obstacle to practice with an unnecessarily high failure rate that places undue burden and expense on recent graduates without any discernible benefit. People will stop "whining" when things change for the better.

 

[Bronze Medal]

No date has been announced. Originally, it was in person orals for March 2020 and March 2021.


I believe it is denial to reject bias to to attractiveness. As I look at my medical school class, the ugly women and short men tend to go into family medicine and the better looking medical students went into ophthalmology, ENT. orthopedics. One medical student told me that she felt she was favored due to her gender and appearance, given more attention and given more informal teaching during the 3rd and 4th years. One chairman said that he purposely selects women because there's a greater chance of women working part time and he wants fewer ophthalmologists. Don't worry, that chairman is no longer chair. Ugly people like me can try to compensate, though, by wearing sharp business attire and preparing for the orals. Those things, I'll do.

“I didn’t pass the oral boards because I’m not attractive enough.”

Ok, sure

 

[Gonio5]

“I didn’t pass the oral boards because I’m not attractive enough.”

Ok, sure

That's a striking conclusion but probably untrue. While a failing answer cannot be turned into a passing answer maybe a weak answer might barely be considered passing if all the right things are present, such as good delivery from an attractive candidate?

During residency, a Fellow said that one examiner was screaming and another examiner tried more than once to get the candidate to change their answer even though the candidate thought the answer given was correct. One of the ABO board members said that in the past there were secret signals used by the examiners in the form of a match box on the desk being opened or closed. For dental licensure exams, one state separates or used to separate in-state applicants from out of state applicants for the practical exam and the out of state room had a high failure rate.

The key is to not get noticed. Prepare then answer the question the best possible and hope for the best. Wear nice clothes, too.

 

[LightBox]

I don't think anyone is arguing that the test can be passed with study. The problem is, it is an expensive, time-consuming, and wholly unnecessary obstacle to practice with an unnecessarily high failure rate that places undue burden and expense on recent graduates without any discernible benefit. People will stop "whining" when things change for the better.

I definitely agree with the expensive part. They should make it like $200 and not pay those Board of Trustees an exorbitant compensation.

 

[Gonio5]

I definitely agree with the expensive part. They should make it like $200 and not pay those Board of Trustees an exorbitant compensation.

While I am not a fan of the orals, I don't think it's true. The CEO gets a big salary but it is calculated to match a big salary of a very successful $1M/year ophthalmologist then reduced by about 20% because the CEO can only work less than part time as an ophthalmologist (about 1 day a week). The board members just get $9000-$12000 per year. The ABO staff makes between $150,000 and $270,000 per year.

There are a lot of expenses, such as renting out so many hotel rooms for meetings and for the oral exam. In addition, they don't pay the examiners so they have to feed them decent meals which the ABO has to pay hotels to prepare. The board members also have expenses.

It's also expensive to make exams and MOC.

 

[LightBox]

Well, seeing that the exams were virtual this year (i.e. no hotel stays and meals), do the examinees get a refund on their oral board fees?

Bright side of COVID19: maybe the Orals will stay virtual from now on!

 

[Gonio5]

Well, seeing that the exams were virtual this year (i.e. no hotel stays and meals), do the examinees get a refund on their oral board fees?

Bright side of COVID19: maybe the Orals will stay virtual from now on!

Ha ha, refund?!

I hope they don't stay virtual. The pass rate is lower with virtual. One possibility is the pass rate is lower because they now have 2 examiners per room and 3 rooms, instead of 6 rooms with 1 examiner. What that might mean is that there is bias. While there might occasionally be the tough examiner that yells when alone with the candidate, there might be more cases where the examiner helps the candidate. When there are two examiners, the examiner doesn't want to be caught being easy so they grade a wee bit tougher but not super tough as to look like a jerk to the other examiner. That causes a lower pass rate than the in person orals.

 

[The Doctor]

I have strong feelings about the ophtho boards, but I am not yet settled in how I should or will feel long term. I passed the written exam on the first attempt, but I had to retake the oral exam once. I find one of the above postings troubling where they write that people should stop "whining" and need to buckle down to study. You are talking about real, very intelligent and committed people who are suffering very real setbacks in their professional careers and personal lives. Many people blaze through without a second though, but a substantial minority experience a lot of difficulty with the exams.

I studied and practiced months and months for my first oral exam and then was not able to get through enough material on my first attempt. I studied once again for months and blasted through the second attempt at high speed and thankfully passed. The oral exam is unusual and we are not prepared for it in residency; additionally, the photographs are notoriously blurry, tangential and sometimes confusing. Data which would be very simple to obtain with a slit lamp exam in clinic is not given, and if you ask you are frequently met with a blank stare. During the examination there is a serious lack of feedback that can be disconcerting for some. In the meantime, having to retake examinations is very expensive and can create a heavy psychological toll on a young graduate who fears for losing his or her job and the ability to provide for their family. I estimate that it cost me personally 20 thousand dollars to pass the exam in time off, loss of productivity, study supplies, online study courses, and in person review courses. It felt troublesome to me to know that I actively practice ophthalmology as conscientiously as I can, listening to patients and evaluating systemic disease routinely, and that I could not pass my oral exam whereas a few other doctors confessed to me that they felt I knew more about rare diseases than they did and they had easily passed. I hear ad nauseum every day from my patients that I am the most thorough doctor they have ever visited. I heard from many of my coresidents that some of the smartest people they knew had to take the exam 2 or 3 times.

On the flip side, having studied three times (months for each attempt and several months again for another attempt that was canceled due to COVID), I have emerged on the other side much stronger and efficient clinically than I started. Being forced to practice a short script for management for hundreds of problems and review imaging, laboratory, and pathology findings is very helpful in day to day practice where I find that I can now much more quickly recognize various presentations of pathology and make a plan for management. In just the last few weeks, I have encountered patients with myasthenia gravis, myotonic dystrophy, JFT type 2, optic nerve pits with serous macular RD's, topless optic discs, optic neuritis, angle closure glaucoma, and myopic foveoschisis, and it felt good to tell them I had been studying all about their conditions and felt confident and prepared to help them.

How then should I feel about my experience long term? I have been forced to learn and consolidate much knowledge along the way, but all I remember is the self-doubt and fear for my job and livelihood which went on for a year. Looking at the statistics, for the most recent written exam 87.6% pass, and for the most recent oral overall 73.1% passed. The pass rate for repeat takers is much lower for the written exam but is about the same for the oral exam as for first time takers. This suggests to me that the written exam has knowledge you simply must know to pass, but failing the oral exam may be completely arbitrary. A substantial minority of our colleagues are not passing the first time through and find themselves stuck as I did. If the goal is to save patients from incompetent practitioners, I'm not sure this makes sense as the candidate is board eligible for 7 years and still practicing regardless. First and foremost, this makes me emotionally feel unlikely at this time to financially support the ABOP or AAO until such time as they increase the first time pass rates for orals. I've seen written above that the goal is to decrease the number of ophthalmologists to keep supply small. I don't understand this either. The baby boomers are coming, and they need eye care. If the ABOP/AAO don't certify MD's/DO's, then optometrists will be more than happy to pretend to fill the gap.

Finally, for those of you still trying to pass the oral exam, I say good luck and hang in there. I used all of the review case books available (Friedman's, Luviano, Pemberton, Wills Manual), went to the Osler course and did many extra solo practice orals, used an online review service called "Eye to Eye" and wrote up practice scripts for 700 cases to practice with friends and family which I drilled incessantly every moment in the car. Using an ophthalmology atlas and referring to pictures in Kanski was also very useful in terms of recognizing the photos they would show you on the exam. I read the eyewiki article for as many topics as I could and searched Google images to review all the photos I could of a given disease. I also found it helpful to make notes identifying commonalities between different cases and their management (for example, common questions to ask about ALL cranial neuropathies --> sx of thyroid eye disease, cancer, trauma, myasthenia gravis, GCA, variability and suddenness of onset; check all other cranial nerves and look for disc edema). The exam isn't so much about your knowledge; it's about 1) being able to recognize what the examiner is asking you with a given picture or scenario, 2) being about to regurgitate key buzzwords about the management of the case, 3) being able to intelligently discuss related diagnoses and how to distinguish them, 4) identify the most likely and the most worrisome diagnoses, and 5) do this quickly and confidently.

 

[Openglobetrotters]

“I didn’t pass the oral boards because I’m not attractive enough.”

Ok, sure

interesting this was brought up. I remember a resident from another program would tell me that regarding orals and also said look at pictorial for derm residents. I thought it was a joke but I guess it’s more commonplace.

 

[Lazyeye9]

I have strong feelings about the ophtho boards, but I am not yet settled in how I should or will feel long term. I passed the written exam on the first attempt, but I had to retake the oral exam once. I find one of the above postings troubling where they write that people should stop "whining" and need to buckle down to study. You are talking about real, very intelligent and committed people who are suffering very real setbacks in their professional careers and personal lives. Many people blaze through without a second though, but a substantial minority experience a lot of difficulty with the exams.

I studied and practiced months and months for my first oral exam and then was not able to get through enough material on my first attempt. I studied once again for months and blasted through the second attempt at high speed and thankfully passed. The oral exam is unusual and we are not prepared for it in residency; additionally, the photographs are notoriously blurry, tangential and sometimes confusing. Data which would be very simple to obtain with a slit lamp exam in clinic is not given, and if you ask you are frequently met with a blank stare. During the examination there is a serious lack of feedback that can be disconcerting for some. In the meantime, having to retake examinations is very expensive and can create a heavy psychological toll on a young graduate who fears for losing his or her job and the ability to provide for their family. I estimate that it cost me personally 20 thousand dollars to pass the exam in time off, loss of productivity, study supplies, online study courses, and in person review courses. It felt troublesome to me to know that I actively practice ophthalmology as conscientiously as I can, listening to patients and evaluating systemic disease routinely, and that I could not pass my oral exam whereas a few other doctors confessed to me that they felt I knew more about rare diseases than they did and they had easily passed. I hear ad nauseum every day from my patients that I am the most thorough doctor they have ever visited. I heard from many of my coresidents that some of the smartest people they knew had to take the exam 2 or 3 times.

On the flip side, having studied three times (months for each attempt and several months again for another attempt that was canceled due to COVID), I have emerged on the other side much stronger and efficient clinically than I started. Being forced to practice a short script for management for hundreds of problems and review imaging, laboratory, and pathology findings is very helpful in day to day practice where I find that I can now much more quickly recognize various presentations of pathology and make a plan for management. In just the last few weeks, I have encountered patients with myasthenia gravis, myotonic dystrophy, JFT type 2, optic nerve pits with serous macular RD's, topless optic discs, optic neuritis, angle closure glaucoma, and myopic foveoschisis, and it felt good to tell them I had been studying all about their conditions and felt confident and prepared to help them.

How then should I feel about my experience long term? I have been forced to learn and consolidate much knowledge along the way, but all I remember is the self-doubt and fear for my job and livelihood which went on for a year. Looking at the statistics, for the most recent written exam 87.6% pass, and for the most recent oral overall 73.1% passed. The pass rate for repeat takers is much lower for the written exam but is about the same for the oral exam as for first time takers. This suggests to me that the written exam has knowledge you simply must know to pass, but failing the oral exam may be completely arbitrary. A substantial minority of our colleagues are not passing the first time through and find themselves stuck as I did. If the goal is to save patients from incompetent practitioners, I'm not sure this makes sense as the candidate is board eligible for 7 years and still practicing regardless. First and foremost, this makes me emotionally feel unlikely at this time to financially support the ABOP or AAO until such time as they increase the first time pass rates for orals. I've seen written above that the goal is to decrease the number of ophthalmologists to keep supply small. I don't understand this either. The baby boomers are coming, and they need eye care. If the ABOP/AAO don't certify MD's/DO's, then optometrists will be more than happy to pretend to fill the gap.

Finally, for those of you still trying to pass the oral exam, I say good luck and hang in there. I used all of the review case books available (Friedman's, Luviano, Pemberton, Wills Manual), went to the Osler course and did many extra solo practice orals, used an online review service called "Eye to Eye" and wrote up practice scripts for 700 cases to practice with friends and family which I drilled incessantly every moment in the car. Using an ophthalmology atlas and referring to pictures in Kanski was also very useful in terms of recognizing the photos they would show you on the exam. I read the eyewiki article for as many topics as I could and searched Google images to review all the photos I could of a given disease. I also found it helpful to make notes identifying commonalities between different cases and their management (for example, common questions to ask about ALL cranial neuropathies --> sx of thyroid eye disease, cancer, trauma, myasthenia gravis, GCA, variability and suddenness of onset; check all other cranial nerves and look for disc edema). The exam isn't so much about your knowledge; it's about 1) being able to recognize what the examiner is asking you with a given picture or scenario, 2) being about to regurgitate key buzzwords about the management of the case, 3) being able to intelligently discuss related diagnoses and how to distinguish them, 4) identify the most likely and the most worrisome diagnoses, and 5) do this quickly and confidently.

congrats man!!! So happy for you

 

[Trefoil]

I guess I will have a stronger opinion if I fail or something, but right now I just see it as another right of passage. I honestly can’t say I was affected by “grandfathering” or anything like that. I’m fortunate that my residency staged several mock oral examinations, but I think in the end, the key is having scripts memorized for common complaints and diseases that kill or blind. I think there is also some importance in recognizing when you have gone off the rails due to a confusing picture and abandoning the ship before it sinks. I think the fact that a single bad case could potentially derail your entire exam is why time management is overly emphasized in this type of exam. Truthfully, in practice, it’s more important to know when you don’t know something and how to find the correct answer to protect the patient. This type of exam penalizes you for that type of thinking. I find myself reframing the exam as a chance to brush up on a bunch of information while reminding myself that it totally is not a realistic way to practice medicine today. In this way, it seems that the exam hasn’t aged particularly well in the age of the internet and sub specialties.

 

[idkididk]

I have strong feelings about the ophtho boards, but I am not yet settled in how I should or will feel long term. I passed the written exam on the first attempt, but I had to retake the oral exam once. I find one of the above postings troubling where they write that people should stop "whining" and need to buckle down to study. You are talking about real, very intelligent and committed people who are suffering very real setbacks in their professional careers and personal lives. Many people blaze through without a second though, but a substantial minority experience a lot of difficulty with the exams.

I studied and practiced months and months for my first oral exam and then was not able to get through enough material on my first attempt. I studied once again for months and blasted through the second attempt at high speed and thankfully passed. The oral exam is unusual and we are not prepared for it in residency; additionally, the photographs are notoriously blurry, tangential and sometimes confusing. Data which would be very simple to obtain with a slit lamp exam in clinic is not given, and if you ask you are frequently met with a blank stare. During the examination there is a serious lack of feedback that can be disconcerting for some. In the meantime, having to retake examinations is very expensive and can create a heavy psychological toll on a young graduate who fears for losing his or her job and the ability to provide for their family. I estimate that it cost me personally 20 thousand dollars to pass the exam in time off, loss of productivity, study supplies, online study courses, and in person review courses. It felt troublesome to me to know that I actively practice ophthalmology as conscientiously as I can, listening to patients and evaluating systemic disease routinely, and that I could not pass my oral exam whereas a few other doctors confessed to me that they felt I knew more about rare diseases than they did and they had easily passed. I hear ad nauseum every day from my patients that I am the most thorough doctor they have ever visited. I heard from many of my coresidents that some of the smartest people they knew had to take the exam 2 or 3 times.

On the flip side, having studied three times (months for each attempt and several months again for another attempt that was canceled due to COVID), I have emerged on the other side much stronger and efficient clinically than I started. Being forced to practice a short script for management for hundreds of problems and review imaging, laboratory, and pathology findings is very helpful in day to day practice where I find that I can now much more quickly recognize various presentations of pathology and make a plan for management. In just the last few weeks, I have encountered patients with myasthenia gravis, myotonic dystrophy, JFT type 2, optic nerve pits with serous macular RD's, topless optic discs, optic neuritis, angle closure glaucoma, and myopic foveoschisis, and it felt good to tell them I had been studying all about their conditions and felt confident and prepared to help them.

How then should I feel about my experience long term? I have been forced to learn and consolidate much knowledge along the way, but all I remember is the self-doubt and fear for my job and livelihood which went on for a year. Looking at the statistics, for the most recent written exam 87.6% pass, and for the most recent oral overall 73.1% passed. The pass rate for repeat takers is much lower for the written exam but is about the same for the oral exam as for first time takers. This suggests to me that the written exam has knowledge you simply must know to pass, but failing the oral exam may be completely arbitrary. A substantial minority of our colleagues are not passing the first time through and find themselves stuck as I did. If the goal is to save patients from incompetent practitioners, I'm not sure this makes sense as the candidate is board eligible for 7 years and still practicing regardless. First and foremost, this makes me emotionally feel unlikely at this time to financially support the ABOP or AAO until such time as they increase the first time pass rates for orals. I've seen written above that the goal is to decrease the number of ophthalmologists to keep supply small. I don't understand this either. The baby boomers are coming, and they need eye care. If the ABOP/AAO don't certify MD's/DO's, then optometrists will be more than happy to pretend to fill the gap.

Finally, for those of you still trying to pass the oral exam, I say good luck and hang in there. I used all of the review case books available (Friedman's, Luviano, Pemberton, Wills Manual), went to the Osler course and did many extra solo practice orals, used an online review service called "Eye to Eye" and wrote up practice scripts for 700 cases to practice with friends and family which I drilled incessantly every moment in the car. Using an ophthalmology atlas and referring to pictures in Kanski was also very useful in terms of recognizing the photos they would show you on the exam. I read the eyewiki article for as many topics as I could and searched Google images to review all the photos I could of a given disease. I also found it helpful to make notes identifying commonalities between different cases and their management (for example, common questions to ask about ALL cranial neuropathies --> sx of thyroid eye disease, cancer, trauma, myasthenia gravis, GCA, variability and suddenness of onset; check all other cranial nerves and look for disc edema). The exam isn't so much about your knowledge; it's about 1) being able to recognize what the examiner is asking you with a given picture or scenario, 2) being about to regurgitate key buzzwords about the management of the case, 3) being able to intelligently discuss related diagnoses and how to distinguish them, 4) identify the most likely and the most worrisome diagnoses, and 5) do this quickly and confidently.

As a PGY-1 who just passed step3... fuuuuuck this never ends

 

[LightBox]

As a PGY-1 who just passed step3... fuuuuuck this never ends

Get ready to be on the bottom of the totem pole... again

 

[Schwann]

I guess I will have a stronger opinion if I fail or something, but right now I just see it as another right of passage. I honestly can’t say I was affected by “grandfathering” or anything like that. I’m fortunate that my residency staged several mock oral examinations, but I think in the end, the key is having scripts memorized for common complaints and diseases that kill or blind. I think there is also some importance in recognizing when you have gone off the rails due to a confusing picture and abandoning the ship before it sinks. I think the fact that a single bad case could potentially derail your entire exam is why time management is overly emphasized in this type of exam. Truthfully, in practice, it’s more important to know when you don’t know something and how to find the correct answer to protect the patient. This type of exam penalizes you for that type of thinking. I find myself reframing the exam as a chance to brush up on a bunch of information while reminding myself that it totally is not a realistic way to practice medicine today. In this way, it seems that the exam hasn’t aged particularly well in the age of the internet and sub specialties.

This Oral Exam does not in any way correlate with the adequacy of the physician. If 25% truly fail, then the abo should start reforming residency training. Sounds like this won't change unless we start voicing our opinions through a petition etc.

 

[Gonio5]

This Oral Exam does not in any way correlate with the adequacy of the physician. If 25% truly fail, then the abo should start reforming residency training. Sounds like this won't change unless we start voicing our opinions through a petition etc.

Petitions will fail. The only way to change would be to become a Manchurian Candidate*, which is one that pretends to support the ABO, become CEO, then have an abrupt change to the exam process. It seems that some other specialties have made it so that the first time pass rate is well over 90%. This last time, about 25% failed the orals and maybe some of them failed the written making it 1/3 of candidates fail at least one time, either the orals or written.

A few specialties have a MOC where you are required to take the same written exam as for initial certification. If the ABO did that, requiring WQE and oral exams every 10 years, the number of board certified ophthalmologist would go way down due to flunking.

(*Manchurian Candidate refers to a well known film about a soldier that was captured, brainwashed by the enemy, and then becomes Vice President or something like that while under the brainwashing spell. I did not watch the 1960's film nor the remake about 10 years ago)

 

[DrQuakerJack]

If the ABO did that, requiring WQE and oral exams every 10 years, the number of board certified ophthalmologist would go way down due to flunking.

Another example of the older doctors eating the young. The new doctors are carrying the burden of the costs of running the Board (2 tests right out of training vs. 1 test every 10 years) while being held to a WAY higher standard than the existing board members. We all know that the majority of practicing ophthalmologists could not pass these tests. Despite this, they are ok with a 25% first-time failure rate.

If the Board was truly about "patient safety," we would all be taking WQE. This is about money.

 

[Trefoil]

Petitions will fail. The only way to change would be to become a Manchurian Candidate*, which is one that pretends to support the ABO, become CEO, then have an abrupt change to the exam process. It seems that some other specialties have made it so that the first time pass rate is well over 90%. This last time, about 25% failed the orals and maybe some of them failed the written making it 1/3 of candidates fail at least one time, either the orals or written.

A few specialties have a MOC where you are required to take the same written exam as for initial certification. If the ABO did that, requiring WQE and oral exams every 10 years, the number of board certified ophthalmologist would go way down due to flunking.

(*Manchurian Candidate refers to a well known film about a soldier that was captured, brainwashed by the enemy, and then becomes Vice President or something like that while under the brainwashing spell. I did not watch the 1960's film nor the remake about 10 years ago)

Haha I have seen the remake actually. Not too bad. Never saw the original.

 

[Gonio5]

Another example of the older doctors eating the young. The new doctors are carrying the burden of the costs of running the Board (2 tests right out of training vs. 1 test every 10 years) while being held to a WAY higher standard than the existing board members. We all know that the majority of practicing ophthalmologists could not pass these tests. Despite this, they are ok with a 25% first-time failure rate.

If the Board was truly about "patient safety," we would all be taking WQE. This is about money.

Wrong! "1 test every 10 years"? No, they got rid of that. To maintain certification, there is no longer a big test that you have to take every 10 years. That test had a roughly 98% pass rate but to help the 2%, they got rid of that exam.

 

[LightBox]

I could never pass the Boards now lol.

 

[Etorphine]

I think a healthy failure rate is probably healthy for the profession. We should limit our supply of ophthos akin to how Derm limits their numbers. Otherwise we cannibalize each other with oversupply.

great idea Lightbox, reduce the # of ophthalmologists by penalizing people that have passed a US residency & are in serious financial debt and then allow 'optometric physicians' to fill in the shortage

 

[Trefoil]

great idea Lightbox, reduce the # of ophthalmologists by penalizing people that have passed a US residency & are in serious financial debt and then allow 'optometric physicians' to fill in the shortage

Actually, derm has a similar number of residency slots today and a lower board fail rate...I’m not sure why the supply is so limited. I guess maybe in the past there were far fewer derm residencies? In any case, the solution wouldn’t be to prevent people who have completed training from practicing, especially with the aging population. There is plenty of pathology to go around, and I think using optometrists to optimize our practice will limit competition between the fields. I do think there are too many optometry schools. I think Canada has like two or three or something for the entire country? They also have far fewer prescribing rights there.

 

[batterup]

wow. 30% fail rate on most recent exam. this is shocking, and alarming trend since going virtual. perhaps I will wait until it returns to live format where stats are more favorable. what do others think about this chart​

​

Oral Examination​

Year	Total Candidates	1st Time Takers	1st Time Takers Passed	Repeat Takers	Repeat Takers Passed	Overall Passed	Overall Failed
2020D	180	156	113 (72.4%)	24	13 (54.2%)	126 (70%)	54 (30%)
2020C	186	147	109 (74.2%)	39	27 (69.2%)	136 (73.1%)	50 (26.9%)
2020B	171	143	110 (76.9% )	28	19 (67.9%)	129 (75.4%)	42 (24.6%)
2020A	102	87	68 (78.2%)	15	11 (73.3%)	79 (77.5%)	23 (22.6%)
2019F	379	336	263 (78.3%)	43	33 (76.7%)	296 (78.1%)	83 (21.9%)
2019S	282	226	194 (85.8%)	56	38 (67.9%)	232 (82.3%)	50 (17.7%)
2018F	338	292	249 (85.3%)	46	35 (76%)	284 (84%)	54 (16%)
2018S	335	277	242 (87.4%)	58	45 (77.6%)	287 (85.7%)	48 (14.3%)
2017F	292	225	187 (83.1%)	67	53 (79.1%)	240 (82.2%)	52 (17.8%)
2017S	337	274	220 (80.3%)	63	41 (65.1%)	261 (77.4%)	76 (22.6%)
2016F	290	199	155 (77.9%)	91	65 (71.4%)	220 (75.9%)	70 (24.1%)
2016S	312	262	190 (72.5%)	50	32 (64%)	222 (71.2%)	90 (28.8%)

 

[pachyworthia]

wow. 30% fail rate on most recent exam. this is shocking, and alarming trend since going virtual. perhaps I will wait until it returns to live format where stats are more favorable. what do others think about this chart​

​

Oral Examination​

Year	Total Candidates	1st Time Takers	1st Time Takers Passed	Repeat Takers	Repeat Takers Passed	Overall Passed	Overall Failed
2020D	180	156	113 (72.4%)	24	13 (54.2%)	126 (70%)	54 (30%)
2020C	186	147	109 (74.2%)	39	27 (69.2%)	136 (73.1%)	50 (26.9%)
2020B	171	143	110 (76.9% )	28	19 (67.9%)	129 (75.4%)	42 (24.6%)
2020A	102	87	68 (78.2%)	15	11 (73.3%)	79 (77.5%)	23 (22.6%)
2019F	379	336	263 (78.3%)	43	33 (76.7%)	296 (78.1%)	83 (21.9%)
2019S	282	226	194 (85.8%)	56	38 (67.9%)	232 (82.3%)	50 (17.7%)
2018F	338	292	249 (85.3%)	46	35 (76%)	284 (84%)	54 (16%)
2018S	335	277	242 (87.4%)	58	45 (77.6%)	287 (85.7%)	48 (14.3%)
2017F	292	225	187 (83.1%)	67	53 (79.1%)	240 (82.2%)	52 (17.8%)
2017S	337	274	220 (80.3%)	63	41 (65.1%)	261 (77.4%)	76 (22.6%)
2016F	290	199	155 (77.9%)	91	65 (71.4%)	220 (75.9%)	70 (24.1%)
2016S	312	262	190 (72.5%)	50	32 (64%)	222 (71.2%)	90 (28.8%)

This test is hot garbage (yes I passed). Yes, let's fail 30% of test takers because they're all unqualified to practice ophthalmology?!? Let's put blurry pictures, some of obscure diseases the candidates have never and will never see in clinical practice?!? Let's show time domain OCTs, or better yet no OCT available in the retina section?!?

 

[DrQuakerJack]

I completely agree. The older docs will blame the candidates for not studying hard enough.

I also passed but I also don’t think the oral boards is an effective way to evaluate candidates. I missed a case with an unusual diagnosis. Even though I knew what the unusual work-up required, I wasn’t given the opportunity to show my knowledge of the work-up and treatment. The exam requires you to “unlock” the opportunity to get more points. The format is not effective.

Most importantly, I think we need to evaluate what the purpose of the board exam. It should be about patient safety. If that is true a) we should not get to practice until we pass, and b) recertification should require the same test. The fact is that the oral boards is much harder than any recertification and the older doctors would have a very high fail rate if held to the same standards. The Board doesn’t want to alienate the older/wealthier docs, so they apply a much higher standard to the new grads.

The Board generally inducts ~650 candidates per year. The CEO of the Board is making $1000 per inductee per year. The Board office manager is making $270k per year (I make $220k doing eye surgery). A lot of things need to change.

 

[medphysik2015]

I think a healthy failure rate is probably healthy for the profession. We should limit our supply of ophthos akin to how Derm limits their numbers. Otherwise we cannibalize each other with oversupply.

Should we just institute a hunger games-like scenario ? Might be more entertaining and effective... just saying.

 

[Trefoil]

wow. 30% fail rate on most recent exam. this is shocking, and alarming trend since going virtual. perhaps I will wait until it returns to live format where stats are more favorable. what do others think about this chart​

​

Oral Examination​

Year	Total Candidates	1st Time Takers	1st Time Takers Passed	Repeat Takers	Repeat Takers Passed	Overall Passed	Overall Failed
2020D	180	156	113 (72.4%)	24	13 (54.2%)	126 (70%)	54 (30%)
2020C	186	147	109 (74.2%)	39	27 (69.2%)	136 (73.1%)	50 (26.9%)
2020B	171	143	110 (76.9% )	28	19 (67.9%)	129 (75.4%)	42 (24.6%)
2020A	102	87	68 (78.2%)	15	11 (73.3%)	79 (77.5%)	23 (22.6%)
2019F	379	336	263 (78.3%)	43	33 (76.7%)	296 (78.1%)	83 (21.9%)
2019S	282	226	194 (85.8%)	56	38 (67.9%)	232 (82.3%)	50 (17.7%)
2018F	338	292	249 (85.3%)	46	35 (76%)	284 (84%)	54 (16%)
2018S	335	277	242 (87.4%)	58	45 (77.6%)	287 (85.7%)	48 (14.3%)
2017F	292	225	187 (83.1%)	67	53 (79.1%)	240 (82.2%)	52 (17.8%)
2017S	337	274	220 (80.3%)	63	41 (65.1%)	261 (77.4%)	76 (22.6%)
2016F	290	199	155 (77.9%)	91	65 (71.4%)	220 (75.9%)	70 (24.1%)
2016S	312	262	190 (72.5%)	50	32 (64%)	222 (71.2%)	90 (28.8%)

That is certainly disconcerting. It would be helpful for them to publish reports explaining the most common reasons people fail. Seeing this number, one would be concerned that a few poorly constructed cases could cause an uptick. What is extremely bothersome is that I’ve heard of cases where they intentionally omit all information excluding the image. You basically have to make a diagnosis based on a single image, which seems completely arbitrary.

I don’t doubt that this test probes knowledge, but I doubt that 30% of residency grads lack critical knowledge to practice safely...