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Ophthalmology. 2010 Dec;117(12):2435-9. doi: 10.1016/j.ophtha.2010.03.056. Epub 2010 Aug 11.

A comparative study of resident performance on standardized training examinations and the american board of ophthalmology written examination.

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Department of Ophthalmology and Visual Sciences, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.



To investigate the relationships between ophthalmology resident performance on the United States Medical Licensing Examination (USMLE), the Ophthalmic Knowledge Assessment Program (OKAP) exam and the American Board of Ophthalmology written qualifying examination (ABO-WQE).


Cohort study.


We included 76 residents from 15 consecutive training classes (1991-2006) at 1 ophthalmologic residency training program.


Numeric scores on the USMLE Step 1 and OKAP examinations during the 3 years of residency, and first attempt pass rate on the ABO-WQE were recorded for 76 residents. Age and gender were also noted. Spearman's rank correlations and univariate and multivariate logistic analyses were performed to determine relevant associations.


First-time attempt pass rate on the ABO-WQE and/or successful completion of the ABO-WQE within 3 years of graduation from the residency program.


The ABO-WQE first-attempt pass rate was 72.6%, consistent with the national average. Resident USMLE scores were not significantly associated with ABO-WQE performance. The ABO-WQE pass rate was significantly associated with OKAP examination scores during the 3 residency years (year 1: odds ratio [OR], 8.85 and 95% confidence interval [CI] 1.82-42.79; year 2: OR, 5.28 and 95% CI, 1.15-25.27; year 3: OR, 11.08 and 95% CI, 1.86-68.96). Passing the OKAP examinations in all 3 years during residency training was associated with 5.43-fold increased odds of passing the ABO-WQE and failing all 3 OKAP examinations was associated with >9-fold lower odds of passing the ABO-WQE on the first attempt.


Our results suggest that OKAP examination performance is a predictor of a resident's success in passing the ABO-WQE on the first attempt, as well as within 3 years of graduation from an ophthalmologic training program. Awareness of this association may permit identification of residents at risk for failing the ABO-WQE and encourage educational remediation to prevent this failure.

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