2026 NBEO Part 3 PEPS Clinical Skills Examination: A
Comprehensive Preparatory Guide with Step-by-Step
Station Evaluation Checklists and Clinical Scenarios
EXAM OVERVIEW AND ADMINISTRATION
Question 1
A candidate preparing for the NBEO Part III PEPS examination must understand the fundamental
purpose and structure of this assessment. Which of the following best describes the primary
purpose of the Patient Encounters and Performance Skills (PEPS) examination?
A) To assess theoretical knowledge of optometric principles through written questions
B) To evaluate a candidate's ability to perform clinical skills and apply knowledge in authentic
patient care scenarios
C) To test memorization of ocular disease classifications and treatment protocols
D) To measure proficiency in practice management and business operations
CORRECT ANSWER: B
Rationale: The PEPS examination is designed to assess a candidate's ability to enter the
independent practice of optometry by evaluating essential clinical skills and the application of
knowledge to patient care in authentic, simulated clinical settings . Unlike traditional written
exams, PEPS requires candidates to demonstrate their knowledge, skills, and abilities through
both psychomotor performance and overall clinical and diagnostic competency .
Question 2
The NBEO Part III PEPS examination was restructured and launched in August 2024. This
restructuring represents a significant evolution from the previous Clinical Skills Examination
(CSE). What is the primary distinction between the former CSE and the current PEPS format?
A) PEPS is administered exclusively through computer-based testing at Pearson Vue centers
B) PEPS requires candidates to demonstrate both psychomotor skills AND overall clinical
diagnostic competency through authentic patient encounters
C) PEPS eliminates the need for skills stations and focuses only on patient interviews
D) PEPS is only offered to candidates who have already completed five years of clinical practice
CORRECT ANSWER: B
,Rationale: While the former Part III CSE required candidates to demonstrate proficiency in some
optometric skills, it did not require proficiency in diagnostic expertise. The restructured PEPS
examination requires candidates to demonstrate their knowledge, skills, and abilities in both the
performance of optometric psychomotor skills AND overall clinical diagnostic competency
through authentic patient encounters .
Question 3
A candidate arrives at the National Center of Clinical Testing in Optometry (NCCTO) in Charlotte,
North Carolina, for the PEPS examination. Upon check-in, they are assigned to a specific testing
pod. How are candidates assigned to their starting stations?
A) Candidates may choose their starting station based on personal preference
B) Starting stations are assigned alphabetically by candidate last name
C) Starting stations are randomly assigned and cannot be chosen by the candidate
D) All candidates begin at Station 1 and rotate sequentially through all stations
CORRECT ANSWER: C
Rationale: Starting stations for the PEPS examination are randomly assigned, and candidates
may start in either a skills station or a patient encounter station depending on their random
assignment. This random assignment ensures standardization and fairness across all testing
administrations .
Question 4
The PEPS examination consists of 12 stations total. A candidate must understand the
distribution of station types to properly prepare for the examination. How many patient
encounter stations and performance skills stations comprise the complete PEPS examination?
A) 8 patient encounter stations and 4 performance skills stations
B) 10 patient encounter stations and 2 performance skills stations
C) 6 patient encounter stations and 6 performance skills stations
D) 12 patient encounter stations and 0 performance skills stations
CORRECT ANSWER: B
Rationale: The PEPS examination consists of 12 stations total: 10 patient encounter stations and
2 performance skills stations. The two skills stations assess anterior segment procedures and
posterior segment procedures respectively .
,Question 5
During the PEPS examination, each station follows a specific timing structure that candidates
must manage effectively. What is the total time allocated for each station, including the
preliminary observation period?
A) 12 minutes total with 2 minutes of observation time
B) 15 minutes total with 5 minutes of observation time
C) 18 minutes total with 3 minutes of observation time
D) 20 minutes total with no observation time
CORRECT ANSWER: C
Rationale: Each station in the PEPS examination provides candidates with three (3) minutes of
preliminary observation time before the official 15-minute exam cycle begins. This observation
time allows candidates to familiarize themselves with the room layout, adjust equipment,
review station information on their device, and prepare for the clinical encounter .
Question 6
A candidate enters a station and begins their three-minute observation period. During this time,
they are permitted to perform certain preparatory actions. Which of the following activities is
NOT permitted during the observation period?
A) Focusing the slit lamp and adjusting equipment
B) Washing hands and disinfecting surfaces
C) Practicing with equipment such as the BIO headset
D) Performing any action on the standardized patient (SP), including asking them to move into
position
CORRECT ANSWER: D
Rationale: During the three-minute observation period, candidates are encouraged to focus the
slit lamp, wash their hands, disinfect surfaces, become familiar with the room layout, and
practice adjusting equipment. However, candidates CANNOT perform any action on a
standardized patient, including asking the SP to move into the slit lamp. Additionally, candidates
cannot open sealed packages during this observation period .
Question 7
The PEPS examination utilizes a fully integrated audio and video recording system throughout all
station encounters. What is the purpose of this recording system?
, A) Only for quality control purposes by NBEO staff
B) Every exam station cycle will be fully recorded (audio and video) for potential review and
scoring
C) Recording is only used for candidate training and development
D) Recording occurs only during skills stations, not patient encounters
CORRECT ANSWER: B
Rationale: Every exam station cycle throughout the PEPS examination is fully recorded with
both audio and video. This comprehensive recording system ensures that candidate
performance can be reviewed as needed for scoring consistency and quality assurance
purposes .
Question 8
A candidate is reviewing the scoring domains for the PEPS examination to understand how their
performance will be evaluated. Which competency domain carries the highest percentage
weighting in the overall examination score?
A) Communication and Professionalism
B) Skills
C) Clinical Assessment and Interpretation
D) Patient Education
CORRECT ANSWER: C
Rationale: The five competency domains in the PEPS examination are weighted as follows:
Clinical Assessment and Interpretation accounts for 29% of the overall score, followed by
Management and Documentation at 25%, Skills at 22%, Patient Education at 13%, and
Communication and Professionalism at 11%. Clinical Assessment and Interpretation is the most
heavily weighted domain .
Question 9
The PEPS examination covers a broad range of clinical presentations across the 12 stations.
Based on the examination blueprint, which clinical presentation category has the highest
percentage weighting in the overall examination?
A) Neuro-Ophthalmic Disease
B) Glaucoma
Comprehensive Preparatory Guide with Step-by-Step
Station Evaluation Checklists and Clinical Scenarios
EXAM OVERVIEW AND ADMINISTRATION
Question 1
A candidate preparing for the NBEO Part III PEPS examination must understand the fundamental
purpose and structure of this assessment. Which of the following best describes the primary
purpose of the Patient Encounters and Performance Skills (PEPS) examination?
A) To assess theoretical knowledge of optometric principles through written questions
B) To evaluate a candidate's ability to perform clinical skills and apply knowledge in authentic
patient care scenarios
C) To test memorization of ocular disease classifications and treatment protocols
D) To measure proficiency in practice management and business operations
CORRECT ANSWER: B
Rationale: The PEPS examination is designed to assess a candidate's ability to enter the
independent practice of optometry by evaluating essential clinical skills and the application of
knowledge to patient care in authentic, simulated clinical settings . Unlike traditional written
exams, PEPS requires candidates to demonstrate their knowledge, skills, and abilities through
both psychomotor performance and overall clinical and diagnostic competency .
Question 2
The NBEO Part III PEPS examination was restructured and launched in August 2024. This
restructuring represents a significant evolution from the previous Clinical Skills Examination
(CSE). What is the primary distinction between the former CSE and the current PEPS format?
A) PEPS is administered exclusively through computer-based testing at Pearson Vue centers
B) PEPS requires candidates to demonstrate both psychomotor skills AND overall clinical
diagnostic competency through authentic patient encounters
C) PEPS eliminates the need for skills stations and focuses only on patient interviews
D) PEPS is only offered to candidates who have already completed five years of clinical practice
CORRECT ANSWER: B
,Rationale: While the former Part III CSE required candidates to demonstrate proficiency in some
optometric skills, it did not require proficiency in diagnostic expertise. The restructured PEPS
examination requires candidates to demonstrate their knowledge, skills, and abilities in both the
performance of optometric psychomotor skills AND overall clinical diagnostic competency
through authentic patient encounters .
Question 3
A candidate arrives at the National Center of Clinical Testing in Optometry (NCCTO) in Charlotte,
North Carolina, for the PEPS examination. Upon check-in, they are assigned to a specific testing
pod. How are candidates assigned to their starting stations?
A) Candidates may choose their starting station based on personal preference
B) Starting stations are assigned alphabetically by candidate last name
C) Starting stations are randomly assigned and cannot be chosen by the candidate
D) All candidates begin at Station 1 and rotate sequentially through all stations
CORRECT ANSWER: C
Rationale: Starting stations for the PEPS examination are randomly assigned, and candidates
may start in either a skills station or a patient encounter station depending on their random
assignment. This random assignment ensures standardization and fairness across all testing
administrations .
Question 4
The PEPS examination consists of 12 stations total. A candidate must understand the
distribution of station types to properly prepare for the examination. How many patient
encounter stations and performance skills stations comprise the complete PEPS examination?
A) 8 patient encounter stations and 4 performance skills stations
B) 10 patient encounter stations and 2 performance skills stations
C) 6 patient encounter stations and 6 performance skills stations
D) 12 patient encounter stations and 0 performance skills stations
CORRECT ANSWER: B
Rationale: The PEPS examination consists of 12 stations total: 10 patient encounter stations and
2 performance skills stations. The two skills stations assess anterior segment procedures and
posterior segment procedures respectively .
,Question 5
During the PEPS examination, each station follows a specific timing structure that candidates
must manage effectively. What is the total time allocated for each station, including the
preliminary observation period?
A) 12 minutes total with 2 minutes of observation time
B) 15 minutes total with 5 minutes of observation time
C) 18 minutes total with 3 minutes of observation time
D) 20 minutes total with no observation time
CORRECT ANSWER: C
Rationale: Each station in the PEPS examination provides candidates with three (3) minutes of
preliminary observation time before the official 15-minute exam cycle begins. This observation
time allows candidates to familiarize themselves with the room layout, adjust equipment,
review station information on their device, and prepare for the clinical encounter .
Question 6
A candidate enters a station and begins their three-minute observation period. During this time,
they are permitted to perform certain preparatory actions. Which of the following activities is
NOT permitted during the observation period?
A) Focusing the slit lamp and adjusting equipment
B) Washing hands and disinfecting surfaces
C) Practicing with equipment such as the BIO headset
D) Performing any action on the standardized patient (SP), including asking them to move into
position
CORRECT ANSWER: D
Rationale: During the three-minute observation period, candidates are encouraged to focus the
slit lamp, wash their hands, disinfect surfaces, become familiar with the room layout, and
practice adjusting equipment. However, candidates CANNOT perform any action on a
standardized patient, including asking the SP to move into the slit lamp. Additionally, candidates
cannot open sealed packages during this observation period .
Question 7
The PEPS examination utilizes a fully integrated audio and video recording system throughout all
station encounters. What is the purpose of this recording system?
, A) Only for quality control purposes by NBEO staff
B) Every exam station cycle will be fully recorded (audio and video) for potential review and
scoring
C) Recording is only used for candidate training and development
D) Recording occurs only during skills stations, not patient encounters
CORRECT ANSWER: B
Rationale: Every exam station cycle throughout the PEPS examination is fully recorded with
both audio and video. This comprehensive recording system ensures that candidate
performance can be reviewed as needed for scoring consistency and quality assurance
purposes .
Question 8
A candidate is reviewing the scoring domains for the PEPS examination to understand how their
performance will be evaluated. Which competency domain carries the highest percentage
weighting in the overall examination score?
A) Communication and Professionalism
B) Skills
C) Clinical Assessment and Interpretation
D) Patient Education
CORRECT ANSWER: C
Rationale: The five competency domains in the PEPS examination are weighted as follows:
Clinical Assessment and Interpretation accounts for 29% of the overall score, followed by
Management and Documentation at 25%, Skills at 22%, Patient Education at 13%, and
Communication and Professionalism at 11%. Clinical Assessment and Interpretation is the most
heavily weighted domain .
Question 9
The PEPS examination covers a broad range of clinical presentations across the 12 stations.
Based on the examination blueprint, which clinical presentation category has the highest
percentage weighting in the overall examination?
A) Neuro-Ophthalmic Disease
B) Glaucoma
