Ophthalmology Knowledge Assessment Program: A rite of passage for residents

One resident wonders, what does your Ophthalmology Knowledge Assessment Program score say to others about you as a resident? With the exception of applying to oculoplastics fellowships, in the global scheme of things, it may make no difference. On the other hand, some residents wished they had done better because they would have been thought of more positively within their program.

Key Points

This annual rite of spring results in a run on Last Minute Optics and frantic attempts to find Chern's Ophthalmology Review Manual, an out-of-print 9-year-old book being offered online for the comical price of $600.

My first-year class has a friendly deal with department chair and Ophthalmology Times Chief Medical Editor Peter J. McDonnell, MD. If our class's average percentile score is 75 or higher, then he will buy the seven of us dinner wherever we want. I am sure he is not losing any sleep, especially with the knowledge that I am going to constitute one-seventh of the final total. I did not want him to get off scot-free, however, so I pushed him to agree that if our average ends up at the 25th percentile or higher, we would get Popeye's.

The "assessment" part suggests that we are supposed to use the results to guide our future studying, which will be the biggest benefit for me. This self-assessment will undoubtedly reveal my weaknesses in rotations I have not had yet, such as oculoplastics, and provide embarrassing examples of deficient knowledge in the ones I have had.

The real source of resident angst, however, is the flip side of this assessment-what your OKAP score says to others about you as a resident. I have talked to former residents from my program, and they universally say that with the exception of applying to oculoplastics fellowships, "Your score doesn't matter." They have the benefit of being further along in their careers, so I trust that in the global scheme of things, it indeed makes no difference.

On the other hand, residents have told me they wish they had done better because they would have been thought of more positively within their program. A friend who is a resident in California told me: "You don't want to be last in your class. You don't have to be first, just don't be last." Somewhere, Vince Lombardi heard those words and wept.

Of course, others cannot judge you based on your OKAP score if they have no idea how you did. The rules state that the only other person who knows your OKAP score is the program director.1 At some programs, scores are actually kept top secret; at others, they are put onto a spreadsheet with the residents' names and then e-mailed to the entire faculty. In fact, the attitude toward OKAPs varies widely, with some residencies blocking off time for residents to attend courses or structuring their lecture series around OKAPs material.

Assuming people find out your score, then, should it matter? There has not been a great deal of published material on the OKAPs, but one study out of Iowa showed that there is no correlation between OKAP score and faculty perception of resident performance.1

Programs (officially, at least) recognize that medical knowledge is just one of the ACGME core competencies for residents. The others-patient care, practice based learning, systems based practice, professionalism, and interpersonal skills/communication-clearly are not tested at all by the OKAPs. Add in the issues with standardized testing in general and variations in structure between programs, and it seems clear that OKAPs should be at most a tiny percent of anyone's judgment of how an ophthalmology resident is doing.

This realization has helped me immensely. When my own score arrives in the mail, my main concern is that my classmates and I will at least get to enjoy a meal of Popeye's fried chicken, red beans and rice, biscuits, and (at participating locations only) Cajun rice.

Parag Parekh, MD, MPA, is an associate at Ophthalmic Consultants of Boston. He completed an anterior segment fellowship with Minnesota Eye Consultants and his residency at the Wilmer Eye Institute, Johns Hopkins University School of Medicine, Baltimore. He earned his MD at the University of Pennsylvania and an MPA in health policy at Harvard's Kennedy School of Government.

Bryan Lee, MD, JD, is a first-year resident at the Wilmer Eye Institute. He earned his MD at Washington University in St. Louis and his JD at Harvard Law School.

Readers may contact Dr. Parekh at parag2020@gmail.com
and Dr. Lee at bryanlee@jhmi.edu
. They both have indicated that they do not have any significant financial interest in any products or companies mentioned.


1. Graff JM, et al. The Ophthalmic Knowledge Assessment Program (OKAP) examination and global evaluation of resident performance. J Academic Ophthalmol. 2008;1:20–24.