The New PEPS and Part 3 NBEO

How to Study for the New NBEO Part 3: A Complete Guide to Passing the Patient Encounters & Performance Skills (PEPS) Exam

For many optometry students, the NBEO Part 3 examination feels like the most intimidating part of the licensure process. Why are there so many unknowns?!

Unlike Parts 1 and 2, which primarily assess your knowledge through computer-based questions, Part 3 evaluates how you apply that knowledge in realistic clinical situations.

The good news? If you've successfully completed your clinical rotations and prepare with a structured study plan, you can walk into the exam with confidence.

This guide will show you how to study effectively for the current NBEO Part 3 examination and avoid the most common mistakes candidates make.

Note: The NBEO periodically updates examination content and procedures. Always review the latest Candidate Guide before your exam. OD on the GO is not affiliated with NBEO.

What Is the NBEO Part 3 Exam?

The NBEO Part 3 examination, also known as the Patient Encounters & Performance Skills (PEPS) examination, evaluates whether you can safely and competently care for patients as an entry-level optometrist.

Unlike multiple-choice exams, Part 3 assesses your ability to:

  • Obtain an efficient patient history

  • Communicate professionally with patients

  • Perform appropriate clinical procedures

  • Interpret examination findings

  • Develop reasonable differential diagnoses

  • Recommend appropriate management plans

  • Document and justify your clinical decisions

Success depends on both your clinical knowledge and your ability to apply it under time constraints.

Think Like a Clinician, Not a Test Taker

One of the biggest adjustments students must make is shifting from memorizing facts to solving patient problems.

Instead of asking:

"What disease is this?"

Ask yourself:

  • What is the patient's chief complaint?

  • What additional history do I need?

  • Which examination findings are most important?

  • What diagnoses should be considered?

  • What testing is needed?

  • What is the most appropriate treatment?

  • When should the patient return?

  • Does this patient require referral?

This clinical reasoning process mirrors how you'll practice after graduation.

Master the Standard Patient Encounter

Nearly every patient encounter follows the same basic framework.

Step 1: Chief Complaint

Start by identifying why the patient is being seen.

Examples include:

  • Blurred vision

  • Red eye

  • Flashes and floaters

  • Diplopia

  • Eye pain

  • Headaches

  • Decreased vision

Step 2: History of Present Illness

Develop the history systematically.

Helpful questions include:

  • When did the symptoms begin?

  • Is the problem constant or intermittent?

  • Is one eye or both eyes affected?

  • Has the condition changed over time?

  • Is there pain?

  • Have they experienced similar episodes before?

A thorough history often narrows the diagnosis before you begin the examination.

Step 3: Perform the Appropriate Examination

Avoid performing every test simply because you know how.

Instead, select the tests that are clinically indicated based on the patient's presentation.

For example:

A painful red eye may require:

  • Visual acuity

  • Pupils

  • Slit lamp examination

  • Fluorescein staining

  • Intraocular pressure (when appropriate)

A patient with flashes and floaters may require:

  • Dilated fundus examination

  • Peripheral retinal evaluation

  • Patient education regarding retinal detachment symptoms

Choosing appropriate tests demonstrates sound clinical judgment.

Practice Speaking Out Loud

Many students spend hours reviewing notes but never practice verbal communication.

During Part 3 you should be comfortable explaining:

  • Examination procedures

  • Findings

  • Diagnoses

  • Treatment plans

  • Medication instructions

  • Follow-up recommendations

Practice with classmates or record yourself explaining common clinical scenarios.

Clear communication builds confidence and mirrors real patient care.

Know the Most Common Clinical Conditions

While any entry-level condition may appear, be especially comfortable managing common disorders such as:

Anterior Segment

  • Dry eye disease

  • Blepharitis

  • Corneal abrasions

  • Corneal foreign bodies

  • Herpes simplex keratitis

  • Herpes zoster ophthalmicus

  • Allergic conjunctivitis

  • Bacterial conjunctivitis

  • Anterior uveitis

Posterior Segment

  • Diabetic retinopathy

  • Age-related macular degeneration

  • Retinal tears

  • Retinal detachment

  • Posterior vitreous detachment

  • Central retinal vein occlusion

  • Central retinal artery occlusion

Glaucoma

Be comfortable with:

  • Open-angle glaucoma

  • Angle-closure glaucoma

  • Ocular hypertension

  • Glaucoma suspects

  • Medication management

  • Follow-up intervals

Neuro-Ophthalmic Disease

Review:

  • Optic neuritis

  • Papilledema

  • Cranial nerve palsies

  • Visual field defects

  • Relative afferent pupillary defects

Develop a Differential Diagnosis

Candidates sometimes jump to a diagnosis too quickly.

Instead, practice generating several possibilities before deciding on the most likely diagnosis.

For every case ask:

  • What is most likely?

  • What is most dangerous?

  • What cannot be missed?

This approach demonstrates safe clinical reasoning.

Practice Documentation

Efficient documentation is an essential skill.

After each practice case, summarize:

  • Chief complaint

  • Pertinent history

  • Examination findings

  • Assessment

  • Plan

  • Follow-up

  • Patient education

The more frequently you practice organizing your thoughts, the easier documentation becomes during the examination.

Review Clinical Images

The PEPS examination expects candidates to recognize common ocular findings.

Practice identifying:

  • Corneal pathology

  • Optic nerve abnormalities

  • Retinal disease

  • OCT images

  • Visual fields

  • Fundus photographs

  • External disease

Learning to recognize classic presentations quickly saves valuable time.

Simulate the Exam

One of the best ways to prepare is by completing timed mock patient encounters.

Set a timer and work through realistic cases while:

  • Taking a focused history

  • Selecting appropriate tests

  • Developing a diagnosis

  • Explaining your treatment plan

  • Documenting your findings

Simulation reduces anxiety because the examination feels familiar.

Common Mistakes to Avoid

Many unsuccessful candidates:

  • Rush the patient history.

  • Skip important examination steps.

  • Fail to explain management decisions.

  • Forget patient education.

  • Miss appropriate follow-up recommendations.

  • Focus only on diagnosis rather than overall patient care.

  • Allow stress to affect communication.

Remember that professionalism and organization are evaluated alongside clinical knowledge.

Study Timeline

Most students benefit from beginning Part 3 preparation approximately two to three months before the examination.

A typical weekly schedule might include:

  • Two days reviewing clinical conditions

  • Two days practicing patient encounters

  • One day reviewing ocular disease images

  • One day practicing documentation

  • One day completing timed mock cases

Short, consistent practice sessions are generally more effective than occasional marathon study days.

Final Thoughts

The NBEO Part 3 examination is designed to evaluate whether you can think and perform like an entry-level optometrist. Success comes from combining strong clinical knowledge with organized communication, sound decision-making, and repeated practice using realistic patient encounters.

Rather than memorizing isolated facts, focus on developing a consistent approach to every patient. Take an organized history, perform appropriate testing, build a thoughtful differential diagnosis, explain your reasoning clearly, and always provide a safe management plan.

At OD on the GO, we've designed our Part 3 review program to mirror the PEPS examination. Our course includes realistic patient encounter simulations, timed practice cases, documentation exercises, clinical scripts, and comprehensive video reviews to help you build confidence before exam day. The more you practice thinking like a clinician, the more prepared you'll be when it matters most.

Dr. Amy and Dr. Emily Study Tips for Part 3

Use part 3 as a script as an actor in a play. Make everything over dramatic as you are now Brad Pitt on the big screen. Practice saying things out loud to hit the rubric in a specific sequence every single time, so when its test day its the same sequence and script and you do not have to worry about if you said it because your brain will take over. OD on the GO has a script and interactive cases to you can practice the same rhythm over and over until it's natural. 

Check out OD on the GO's top product- part 3 study aid!