PEPS, station by station
Twelve stations, nine categories, five scoring domains and two skills stations: how the Part III day actually runs.
Part III changed in August 2024. The Clinical Skills Examination is gone, and PEPS, Patient Encounters and Performance Skills, is what you now sit at NBEO's National Center of Clinical Testing in Optometry in Charlotte, North Carolina.
The shape of the day
There are 12 stations, all with standardized patients: ten patient encounters and two performance skills stations. Before each station you get 3 minutes with an overview on your device, then 15 minutes for the station itself.
The ten encounters
Each encounter is a case. You take a focused history, interpret the findings you are given, reach an assessment and a plan, and explain it to the patient. The ten encounters cover each of NBEO's nine clinical categories once, with a tenth drawn at random from the nine. The 2026 to 2027 candidate guide notes that one encounter is included for data collection only.
| Category | Blueprint weight |
|---|---|
| Anterior segment disease | 17 |
| Posterior segment disease | 16 |
| Glaucoma | 14 |
| Systemic disease | 11 |
| Refraction | 11 |
| Neuro-ophthalmic disease | 9 |
| Contact lenses | 8 |
| Binocular vision | 8 |
| Pediatrics | 6 |
The two skills stations
- Anterior segment: biomicroscopy, Goldmann applanation tonometry and 4-mirror gonioscopy.
- Posterior segment: binocular indirect ophthalmoscopy and dilated biomicroscopy with a non-contact fundus lens.
NBEO publishes the evaluation forms for both skills stations. Practice against them, because they show exactly what an examiner looks for.
How it is scored
Items are scored on whether you did something and how well you did it, across five domains: clinical assessment and interpretation (29), management and documentation (25), skills (22), patient education (13), and communication and professionalism (11). Education and communication together carry 24 points, so the conversation matters as much as the findings.
How to prepare
- Rehearse each skill the same way every time until it is automatic, with a partner and a timer.
- Practice full encounters out loud and end every one with a specific plan: drug, strength, dose, frequency, duration and follow-up.
- Run all 12 stations back to back at least once before the exam.
The station drill on the Part III guide gives you the 3-minute prep, the 15-minute clock and a checklist for each station.