Mastering the question: tips and examples for effective ophthalmology exams
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Well-constructed questions allow examiners to identify which candidates have the necessary competence to practice as ophthalmologists.
Effective ophthalmology exam questions must be clinically relevant, fair, and well-constructed, allowing examiners to confidently distinguish between candidates who have the necessary competence and those who do not.
We recommend following a step-wise approach.
Step 1. Overall exam design Start by creating a blueprint that aligns the overall exam content with the course objectives and curriculum, at the level of complexity required for the learners (e.g., medical student vs. ophthalmology fellow).
Step 2. Review team Assemble a review team of subject matter experts or colleagues who understand question development and best practice.
Step 3. Question design Design questions that require candidates to apply their knowledge and clinical reasoning skills, rather than simply recalling isolated facts.
• Use patient scenarios that mirror real-world situations and include only information that is relevant to the problem.
• Question types like single best answer or extended matching questions work well. They have one clearly correct option and plausible wrong answers.
• Avoid negative phrasing (e.g., “Which one is NOT a beta-blocker?”). If this is unavoidable, highlight or capitalise the negative word, as in the example above. This is to reduce the risk that the student will make a mistake that reflects their ability to read under pressure, rather than their actual level of knowledge.
• All answer options must be grammatically consistent and similar in length, so that candidates can’t easily guess the correct answer.
• Do not use absolute terms like ‘always’ or ‘never’ in the answer options – these usually suggest an incorrect answer.
Avoid using “All of the above” and/or “None of the above” as answer options like these test students’ exam strategies more than their actual understanding.
Step 4. Review and pilot test
After writing, the questions should undergo a formal review process by experts and potentially be pilot tested to ensure quality, difficulty, and their ability to effectively discriminate between students with higher and lower levels of understanding.
Sample questions
The following questions have been peer reviewed and are of the standard used in the Ophthalmology Foundation exams.
1. Visual science
Which ONE of the following is most likely to be true of conditions with mitochondrial inheritance?
a Affected fathers transmit the condition
b They follow a recessive inheritance pattern
c They are passed exclusively by mothers
d They only affect males
Answer: c. They are passed exclusively by mothers (because mitochondrial DNA is inherited maternally).
2. Optics, refraction, and instruments
a Which ONE of the following clinical scenarios is MOST likely to result in pseudo-neutralisation during retinoscopy?
b Performing retinoscopy on a child without cycloplegia.
c Performing retinoscopy under mydriasis with full cycloplegia.
d Retinoscopy in a pseudophakic eye with a centered IOL.
Use of trial lenses with appropriate working distance.
Answer: a. Performing retinoscopy on a child without cycloplegia.
3. Clinical ophthalmology
The clinical finding of multiple, yellowish, ill-defined sub-retinal pigment epithelium (RPE) deposits, as seen in this image (Figure 1, see cover image) from a patient with primary intraocular lymphoma (PIOL), most closely mimics the fundus appearance of which of the following acquired conditions, often leading to misdiagnosis?
a Best’s vitelliform macular dystrophy
b Acute retinal necrosis syndrome
c Birdshot choroiditis
d Retinal vein occlusion (RVO) sequelae
Answer: b. Acute retinal necrosis syndrome.
The Ophthalmology Foundation team is pleased to support educators in developing high-quality assessment content and welcomes question submissions for review and feedback at exams@ophthalmologyfoundation.org.