Some have addressed the OKAP exam from different angles (such as its importance, etc) on SDN, but I haven't seen enough discussion on how to approach it seriously. I am writing this as a starting place for my future residency (I matched for 2014). If you feel like contributing, please by all means speak up. I need experienced input.
General areas of interest are: timing, Qbanks, texts. After addressing these, I have other things to say about the test from my research.
Executive Summary:
1. I will read 10 BCSC sections, deferring Neuro and Optics to Kline-Bajandas and Hunter respectively, by Feb 28. I will study an average of 20 pg/day until March at which time I will switch to review texts and Qbanks only; however before then I will try to incorporate other texts as I am able.
2. Besides BCSC texts I will use Tamesis, Friedman, and Melendez Audio throughout the year as place fillers.
3. I will take all BCSC (~600), Tamesis (~3000), and Provision (~550) Qs; totaling 4150 Qs. Friedman has questions that I will take as needed.
4. Texts I will definitely use: BCSC, Tamesis, Friedman, Hunter, Kline-Bajandas, and Provision.
5. Texts I may use: Melendez Buzzwords and Kanski Atlas.
6. Texts I will not likely use: Lamkin, Chern/Wright/Saidel, Eagle.
*TIMING*
First, the exam can take place anywhere from the end of March to the beginning of April. Planning, therefore, should be weighted to the first half of the PGY 2 year in order to be ready. I've read that PGY 4 OKAP performance best correlates to certification outcomes, so it's possible that some will tend to deemphasize PGY 2 study.
A disproportionate number of residents, professional instructors and others claim in almost every place I've looked that studying the Basic and Clinical Sciences Course (BCSC) is the best preparation for the OKAP. Timing stems from completing the 12 book series.
The following is taken from AAO's website for 2012-2013 as a way to study the BCSC. It seems nice. It doesn't include the Update on General Medicine section (Section 1) and I've heard from some that one should not spend time on Section 1 for the PGY 2 year exam because of intern year exposure.
AAO claims following this schedule will require you to cover 120 pages/week, but by my math it's more like 140-150. That seems reasonable as some weeks will be more productive and others less (like the beginning of PGY 2). They also claim the most high-yield books are scheduled for earlier in the year with weight given to junior residents' needs.
July 15 - Aug. 4: Fundamentals and Principles of Ophthalmology (397 pages, 20 pg/day)
Aug. 5 - 18: Lens and Cataract (231 pages, 18 pg/day)
Aug. 19 - Sept. 1: Glaucoma (220 pages, 17 pg/day)
Sept. 2 - 22: Retina and Vitreous (371 pages, 19 pg/day)
Sept. 23 - Oct. 13: External Disease and Cornea (445 pages, 22 pg/day)
Oct. 14 - 27: Orbit, Eyelids, and Lacrimal System (278 pages, 21 pg/day)
Oct. 28 - Nov. 17: Ophthalmic Pathology and Intraocular Tumors (352 pages, 18 pg/day)
Nov. 18 - Dec. 22: Pediatric Ophthalmology and Strabismus (418 pages) and Refractive Surgery (217 pages).. total: 635 pages, 19 pg/day
Dec. 23 - Jan. 1: Break for the holidays
Jan. 2 - 19: BCSC - Intraocular Inflammation and Uveitis (319 pages, 19 pg/day)
Jan. 20 - Feb. 9: Neuro-Ophthalmology (369 pages, 19 pg/day), see Kline (below) as alternative
Feb. 10 - 28: Clinical Optics (323 pages, 40 pg/day), see Hunter (below) as alternative
Feb. 28 - March 30: Tamesis, Kanski Atlas, Melendez Buzzwords, Provision Series (more on these in the Text section)
Throughout the year, in "free time": Friedman, Tamesis, Melendez Audio (more on these in the Text section)
Strategy summary: I plan to study 1 hour daily, no matter what. Given that I will be studying for the 2015 OKAP, I will probably have to recount, as the above is for 2012-2013 and BCSC is updated every year. It looks like if I read 20 pages/day, I'll be safe. Then I plan to mix in those texts noted in the "Throughout the year" section. I'm not sure how that will work because BCSC study seems burdensome as such. I'll have to play that one by ear. Maybe on call, after BCSC has been covered, I can go in that direction. I've heard that many consult the pathology section of BCSC during their review in the 3-4 weeks before the end of March.
*QBANKS*
I've encountered a number of resources, and from those some strategies have developed. Before I discuss strategies, I'll address available resources:
1. BCSC Qs: The first resource and what seems to be the most popular is to use the Qs in the back of the BCSC texts. I've read that some will only consult those in the Feb/March review. This seems like a big risk and myopic given the length to which book companies are making resources. I've look at the 2011-2012 BCSC texts and found that they only have 50 or so Qs per book (average length being 400 or so pages per book). 50 Qs in 12 books (600 total) seems insufficient alone.
2. Tamesis, Lamkin, Hunter: Apparently the review texts (see texts) have questions near their indices. Because I don't own any and the Amazon previews are limited, it's hard to say with all of them. The Tamesis and Lamkin texts only contain questions; their purpose is to serve as a paper Qbank. Tamesis' text claims to have 3,000 Qs. I can't find similar numbers for Lamkin. Hunter's last minute optics text is question-based, but it's Socratic and not a true test of knowledge. I've read from some that the Lamkin (MEEI) text is too esoteric for OKAP. Tamesis seems to have a better reputation. Both address general ophthalmology topics concordant with BCSC sections. Maybe someone can give some input here. Hunter seems like a no-brainer because optics itself is important. Kanski's review atlas seems like an obvious choice as well but maybe less comprehensive. It is a book full of picture quizzes that are often used in the OKAP.
3. Ophthoquestions: I have found some electronic Qbanks. The first I found was ophthoquestions.com. It seems like a nice way to study. You can sample their product before purchase (prices are like USMLE World, with same subscription architecture of 6 months, 12, etc). They claim to have 3116 questions but you cannot reset them after use. There is also a non-profit at ophthodeck.com that produces a free Qbank. It is severely limited, has a shoddy interface (you can see the correct answer below the question), and the quality seems suspect.
4. Provision: The AAO, in its ONE Network, has two Qbanks under the name Provision. Currently they are selling two services: Provision Series 5 and Provision: Preferred Responses in Opthalmology: Series 4. The Provision Series 5 is sold out, which probably means residents are using the print version; it must be popular. Both Series 4 and 5 have online and print versions with correspondent price changes (higher prices for print + online, lower for print only, etc). I don't have any informed opinions about this since I can't find many mention of it in internet forums. Given that it's popular (assumed from supply status), maybe getting the online version would be a good idea, with the optional print version. I've read from one blog that Provision questions tend to be easier than OKAP Qs.
Strategy summary: I plan to take the BCSC quiz questions after each book (~600 Qs) and the 3000 Tamesis Qs throughout the year, and then the Provision Qs in Feb/March review. Hunter seems like a reasonable set of optics Qs and a good substitute for BCSC's section. Provision 5 contains 550 Qs and Provision 4 contains 450. Assuming the 2014-2015 edition will have 550 I will have gone through 4150 Qs before my PGY 2 OKAP. Not knowing what the Provision print version looks like or how it differs from the online (is it a supplement?), this may change with experience. I'm leaning to Tamesis given Lamkin's poor reputation. ophthoquestions.com seems like an unnecessary purchase, but maybe it's something one could take advantage of in the Feb/March review because of its month-to-month pricing. Kanski's Atlas will be a big temptation but I think I'll place it in the ophthoquestions.com category because of how much exposure I will be getting in other places.
*TEXTS*
I will try to reference my study strategy into these texts, but the main purpose here is to discuss these texts' reputations and general purpose.
1. BCSC series (renewed every year)
- Seems to be the consensus primary study text. Most people on the web think it can be finished by Feb/end of Jan. I plan to read all 10 sections, exempting the Optics section in deference to Hunter (optics) as I've heard this is all one needs and it's shorter than BCSC. I will probably skim General Updates to be safe.
2. Chern/Wright: Ophthalmology Review Manual (last ed: 2011)
- This seems like a nice book. The latest edition has Saidel, rather than Wright, as coeditor. The amazon reviews are generally positive, though one notes weaknesses in neuro and optics. The book itself looks like First Aid in its structure, images, etc. I can't say that I would open it until Feb/end of Jan (if I get it at all) because I plan to occupy myself with Friedman, Tamesis, and others who are tried and have many editions in under their belts.
3. Chern/Wright: Review Questions in Ophthalmology (last ed: 2005)
- I heard about this book on this forum from an attending. It looks like a nice compliment to Friedman or other review texts. The only issue I see is that its last edition is almost 10 years old. Tamesis is only a year younger, so it could be that this is how things are these days anyway.
3. Tamesis: Ophthalmology Board Review (last ed: 2006)
- Of all of the review texts, as with BCSC, Tamesis seems like an essential and a consensus. It's a Qbank book with short Qs and short answers. I found these helpful in medical school and I suppose it would be good in ophthalmology as well. I like that these texts tend to address memorize-only things (like eponyms).
4. Lamkin: MEEI Review Manual for Ophthalmology (last ed: 2011)
- Rob Melendez, author of a famous audio review, has said that this is too detailed and overwhelming as it's not representative of OKAP structure or style. I have found some who swear by the book. Because of the number of texts available, I might hold off on purchasing as there will be considerable overlap with other "proven books," like Tamesis and Friedman.
5. Hunter: Last Minute Optics (last ed: 2011)
- I've read that most of what one needs in optics for OKAP is in this text. The editorialist who made this statement also suggested that the optics text in BCSC is too big/technical to read like a study book and more suited for reference. Therefore I will read this in the Feb 10-28 interval, in place of the BCSC section.
6. Eagle: Eye Pathology: Atlas and Basic Text (last ed: 2011)
- I saw this mentioned in one blog. In my admittedly irresponsible scanning of the text I found it too wordy and too thorough. Perhaps from the BCSC text pathology I'll decide if I need this in my review. Until then I'm counting it out.
7. Friedman: Review of Ophthalmology (last ed: 2012)
- This is the standard issue, bread and butter of many programs. It looks like Goljan in its structure and language (short and bulleted with colored images). I've also read that it is a good companion throughout the day for the "free" moments (much like Tamesis). Perhaps one has to decide whether the Chern/Wright/Saidel text is better than Friedman, or visa versa, and pick one over the other. From my superficial study this looks a little more in-depth and more appropriate for the needs of a resident. It also has quiz questions for each chapter which is not found in Chern/Wright/Saidel.
8. Kline and Bajandas: Neuro-ophthalmology Review Manual (last ed: 2007)
- I've read that the neuro-ophthalmology section of BCSC is poorly written and that this is a good replacement. Of course this opinion was written in 2010, so perhaps things have changed. I'm going to purchase the whole BCSC series so maybe I'll try to find the old BCSC (from 2010) and compare it with the one from which I will study (2014-2015) before getting too dedicated.
9. Melendez: Ophthalmology Buzzwords (edition date unknown)
- One source says this is good for "passive learners." Sometimes that is my description. I can't say that I would want to stretch myself this much, but it may be a good resource for others. I plan to not purchase this in deference to Tamesis, but after finishing it (if that happens), I'll consider it.
10. Kanski: Test Yourself Atlas in Ophthalmology (last ed: 2008)
- An image review text with very few words. It has a good reputation for preparing residents to see images and think of diagnosis with very little information. This might be more appropriate for end of study, during the 3-4 weeks before the OKAP. I do plan to purchase it as I believe that at a certain point I'm only going to want to look at books rather than read them thoroughly.
11. Kanski: Clinical Ophthalmology (last ed 2011)
-I'm getting a lot of PMs suggesting that this should be added as well. It is supposedly far and away the best introductory/intermediate level text. Quoting from one correspondent: "It takes about 3 months to get through at 10 pages/day, but it has great pictures that SHOW what things are and text that EXPLAINS what things are in an easy to understand and easy to remember fashion, unlike many of the other sources you listed. I found it much easier to go through the BCSC having read Kanski once, and much less painful starting residency knowing many of the terms and fundamental clinical concepts." I've started to read it in MSIV and I really like it. I've almost finished the lids section. While I don't think I'll retain everything, because it's really thorough, I like the introductory language.
OTHER NOTES
1. OKAP/Step1/WQE predictions research: The journal Ophthalmology has published several studies on resident performance in the Written Qualification Exam (WQE) and its relationship to OKAP and USMLE Step 1. WQE is the 250 Q, written exam given to residents by the American Board of Ophthalmology that determines, in part, their eligibility for the Oral Examination pursuant to receiving certification. I'll summarize Ophthalmology's findings: OKAP performance correlates significantly with WQE, but Step 1 does not correlate significantly with either OKAP or WQE.
2. The subject areas covered in the OKAP differ from topics in the BCSC and differ from those in WQE. There are 11 areas covered in the OKAP: Medicine; Fundamentals and Principles of Ophthalmology; Optics, Refraction, and Contact Lenses; Ophthalmic Pathology in Intraocular Tumors; Neuro-ophthalmology; Peds Ophthalmology and Strabismus; Orbit, Eyelids, and Lacrimal System; Cornea, Lens, and External Disease; IO Inflamation and Uveitis; Glaucoma; and Retina and Vitreous.
**Resources**
#. AAO schedule:
OKAPs Reading Schedule
#. Good lecture-based review:
Ophthalmology Residency Program | New York Eye & Ear
#. One AAO representative on OKAP prep:
OKAP Resources
#. Melendez's blog:
http://eyepearls.medrounds.org/2010/02/okap-preparation-pearls.html and
http://eyepearls.medrounds.org/2010/02/golden-pearls-for-okap-exam.html
#. OKAP/WQE ref:
A multicenter analysis of the ophthalmic knowledge assessment program and American Board of Ophthalmology written qualifying examination performance. - PubMed - NCBI and
A comparative study of resident performance on standardized training examinations and the american board of ophthalmology written examination. - PubMed - NCBI
