11.2  Preparing for the Examination

1. Be Aware of the Exam Structure and Location

  • This sounds obvious but understanding how you will be examined is crucial. Find out as soon as possible the dates, duration, length of each station, and how the examination is marked. If the examination is not held in your home city, travel to the examining city and familiarise yourself with the layout of the clinic the day before the exam. Work out how you are going to get to the exam and how long it will take – there is no excuse for being late. Preparing your travel in advance will also free your mind on the morning of the examination to relax. If your examination will be held virtually online, it is important that you are familiar with the computer setup

2. Organise Your Study Groups Early

  • You cannot pass clinical examinations alone. You can always learn something from another candidate. Small groups are best (three to four participants) as groups larger than this can lack focus. Pick your group wisely – they will be your harshest critics and (hopefully) become friends for life. If it is difficult to meet in person, online teleconferencing is invaluable

3. Predict What May Be Asked

  • Speak to people who have just passed the examination - they are your best resource for what and how to study. Practice, and mercilessly critique your answers to recent examinations. Know what is “topical” in ophthalmology at the time the examination is set and revise this material accordingly. Think about common surgical scenarios, such as when you would independently do a phacoemulsification or trabeculectomy versus a combined phaco-trabeculectomy
  • Once you gain experience with the exam format and style, start to write your own questions for your study group. Mark them yourself to see where gaps in your own knowledge are

4. Study From the Correct Resources

  • This depends on the current examination structure and what you predict may be asked. Unfortunately, textbooks rarely capture the nuance of clinical decision making and the juggling of multiple problems and patient factors that is so crucial to exit examinations, so these cannot be your only resource. Recent graduates may have access to collections of notes which are often superior to published texts
  • Commonly recommended texts and journals include: Kanski’s Clinical Ophthalmology [i], The Wills Eye Manual [ii], the AAO Basic Clinical Science Course [iii] series, AAO Focal Points articles, The Ophthalmology Examinations Review [iv], The Neuro-ophthalmology Survival Guide [v], the journal Current Opinion in Ophthalmology and of course this book!
  • Know the larger trials (especially randomised controlled trials): OHTS, NTG, EMGTS, AGIS, CVOS, BVOS, ANCHOR / MARINA, CATT, DRCR.net, EVS, ONTT, EUGOGO etc. but do not get mired in detail – see Section 11.5 Evidence-Based Medicine with respect to Exit Examinations

Kanski JJ. Clinical Ophthalmology A Systematic Approach, Sixth Edition. Sydney: Elsevier Butterworth-Heinemann, 2007.

Ehlers JP, Shah CP. The Wills Eye Manual. Office and Emergency Room Diagnosis and Treatment of Eye Disease. Fifth Edition. Sydney: Lippincott Williams & Wilkins, 2008

Basic and Clinical Science Course. San Francisco: American Academy of Ophthalmology, 2010.

Wong TY. The Ophthalmology Examinations Review. Singapore: World Scientific, 2001.

Pane A, Burdon M Miller NR. The Neuro-Ophthalmology Survival Guide. Sydney: Mosby Elsevier, 2007.

6. Get to as Many Tutorials / Courses / Conferences as Possible

  • This is your time to study. Hopefully your juniors will understand this and cover you as much as possible. Remind them that their time will come too! As much as possible, immerse yourself in ophthalmology and exam preparation for the months prior to the exam. Allocate a member of your cohort or study group to coordinate tutorials with consultants (attendings) – most are happy to help, and some will be very experienced in giving these tutorials

7. Start Doing Practice Exams Now

  • You must do practice exams under exam conditions. This means timing yourself and having colleagues assess your answers. You will find that the time is much less than you think. Knowing everything about a topic does not mean that you will pass. Knowing the most important points (in order), will. It is never too early to start doing practice exams

8. Make the Most of your Patients

  • This is a management exam. It tests what you do every day in your work. Transform the service obligation in your job into study time by treating every patient you see as an examination question. Independently generate management plans, and then employ your consultants’ (attendings’) experience to harshly critique your management plans
  • When you see a patient with a rare diagnosis, write down everything you can remember about them - how they presented, what their eye looked like and the results of investigations. Taking photographs of interesting diagnoses is an invaluable resource. If you are asked about a particular clinical scenario, think back to what you did with that patient. Practical knowledge counts for just as much (if not more) as book knowledge. Finish by writing an exam question about that diagnosis and giving it to your study group

9. Write Down Your Questions, and Ask, Ask, Ask!

  • When you come across something that you don’t understand, write it down and ask your study group and your seniors when you get a chance

10. You Cannot Hide

  • This exam will find your weaknesses. Don’t attempt an exit examination without adequate prior study. Work on your weaknesses, not on your strengths - you will pass if you are solid on all stations but fail if you are excellent on some and terrible on others

11. You can Never be Fully Ready for the Examination

  • There will always be more that you can know and learn. Have the confidence to believe in your abilities and remember that the real learning begins after you have passed your exam

12. Get Enough Sleep in the Days Prior to the Exam

  • There is nothing that you can learn in the night prior to exam that will compensate for a tired mind


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