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CERTIFICATION EXAMINATION INSTRUCTIONS TO CANDIDATES |
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Blueprint of the distribution for questions on the examination (pdf) |
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NATURE AND SCOPE OF THE EXAMINATIONThe ACVO Certification Examination is given annually to candidates who have successfully completed all requirements as dictated by the ACVO Residency and Credentials Committees. The examination process consists of three separate sections: 1) the Image Recognition examination, the Written examination, and the Practical examination. The examination series is held each August, usually at a veterinary teaching institution.
The portions of the examination are constructed to evaluate the candidate's proficiency and knowledge of items considered relevant and important to a veterinary ophthalmologist. The Image Recognition examination is designed to evaluate ability to identify, assess, and problem solve (assimilate) clinical material. The Written examination is designed to evaluate knowledge of the current scientific literature and basic sciences relevant to veterinary ophthalmology. The Practical examination portions are designed to evaluate proficiency in ophthalmic examination techniques and surgical techniques.
COMPONENTS OF THE EXAMINATIONThe Image Recognition examination consists of a series of images and corresponding questions in three sections of the eye and related structures: 1) Orbit and Adnexa, 2) Anterior Segment, and 3) Lens and Posterior Segment.
The major demands of the Image Recognition examination include identification, assessment, and problem solving (assimilation) of the appearance and information presented on a photographic image. The Image Recognition examination is conducted in a nonverbal fashion, and candidates are asked to respond to structured questions with a short answer written response while viewing the image. The candidates are given approximately 2 to 2.5 hours per section to complete the exam. The candidates are generally asked to give several answers for each image.
The images used in this part of the examination include clinical photographs of the eye or patient, fundus photographs, goniophotographs, photographs of imaging techniques, special diagnostic techniques, slitlamp photographs, cytologic specimens, and gross and microscopic (photomicrographs) pathology specimens. Questions on surgical techniques, principles, equipment and complications are also covered in each of these three areas. Questions typically include such items as listing lesions or abnormalities, developing a differential considerations list for the specific disease process, citing the most likely etiologic diagnosis(es) or pathogenesis, listing a morphologic diagnosis, listing appropriate therapy for the specific condition, identifying species on the image, identifying the surgical technique being performed, surgical instrument, or surgical principle relevant to the image, or surgical complication. The phrasing of questions on the Image Recognition examination follows the guidelines outlined in the terminology description below.
As this exam is designed to evaluate recognition and assimilation of clinical material, the candidate can best prepare for this portion during the residency by seeing a full and diverse caseload and developing sound problem solving skills. Preparation for this portion of the exam is also facilitated by reviewing kodachrome or digital images of the subject content listed above and interpreting the images according to the questions likely to be asked. Distribution of Image Recognition Questions PART I. ORBIT AND ADNEXA
PART II. ANTERIOR SEGMENT
PART III. LENS AND POSTERIOR SEGMENT
See blueprint for specific species and discipline number of questions. Appropriate Terminology for Answers to Image Recognition Examination Section The following list of terms has been approved by the Examination Committee for use in questions on the ACVO Image Recognition examination. The candidates should familiarize themselves with this list in preparation for the certification examination. Though there may be differences of opinion with regard to the correct usage some of these terms, this is the terminology the Committee has determined to use on the Image Recognition exam. The term to be used on the examination is listed first, followed by synonyms with which the term is often used (these synonyms will not generally be used on the exam), followed by examples of what the term represents:
TERM SYNONYMS EXAMPLES
ABNORMALITY conditions corneal edema features keratic precipitate lesions retinal detachment significant findings granulomatous inflammation clinical signs hypolucent area hyperfluorescence
Note that abnormality can refer to clinical findings, histopathologic or cytologic findings, and findings in ancillary tests such as gonioscopy, fluorescein angiography, radiography or other imaging techniques, laboratory tests, etc. The question may be stated as, list the "clinical abnormality" or list the "histopathologic abnormality," etc. If asked for an abnormality, the candidates should list what they see, not the interpretation of what they see, and the abnormality should be described in as much detail and to the highest level possible from what is shown on the image. For example, the image may depict corneal edema, and if the examiners felt the image adequately depicted this lesion, the candidate would be expected to list this as an abnormality, not "corneal cloudiness" or "white area in the cornea." Note that with a fundus photograph, which clearly shows a retinal detachment, the abnormality would be listed as a "retinal detachment." However, with an ultrasound the abnormality should be listed as "hyperechoic lines radiating from optic disc and extending into vitreous". In the latter example, retinal detachment would be a DIAGNOSIS. The examiners take these types of terminology overlap into consideration when formulating the questions and assessing the candidate's answers. Do not assume that if the question asks for any abnormalities that one is necessarily present. If no abnormality is present, the candidate would be expected to write "normal" or "no abnormality." Likewise, the question may ask for “the most significant abnormalities” with a number of correct responses accepted. However, if a lens luxation and retinal detachment are present, listing conjunctival hyperemia instead will not be accepted.
TERM SYNONYMS EXAMPLES
DIAGNOSIS differential diagnosis anterior uveitis conditions primary glaucoma interpretation lymphocytic/plasmacytic anterior uveitis disease melanoma (morphologic diagnosis) process internal ophthalmoplegia
Diagnosis refers to an interpretation of the abnormalities or findings. The question may be qualified to ask for a "histopathologic diagnosis," "morphologic diagnosis," "clinical diagnosis," an "ultrasonographic diagnosis," etc. Again, the diagnosis should be listed in the most specific terms possible from the findings on the image and the information given in the question. Diagnosis will generally not be used to refer to a specific cause.
TERM SYNONYMS EXAMPLES
ETIOLOGIC DIAGNOSIS differential diagnosis E. coli syndromes VKH-like syndrome causes trauma underlying cause systemic hypertension causative agent
Etiologic diagnosis refers to a specific cause for the abnormalities or diagnosis. The question may be qualified and ask for an "etiologic factor," "etiologic agent," a "noninfectious etiologic agent," etc. An etiologic diagnosis is more specific than a clinical diagnosis.
TERM SYNONYMS EXAMPLES
PATHOGENESIS mechanism autoimmune disorder account for UV light exposure reaction type II hypersensitivity pathophysiology fluid vitreous entering subretinal space through retinal tear
Pathogenesis will be used to refer to the cellular events and reactions or other pathologic mechanisms occurring in the development of a disease. It is distinguished from "etiologic diagnosis" by being more specific and referring to mechanism (often cellular) rather than cause (such as a microbe, trauma, etc.).
MISCELLANEOUS TERMINOLOGY:
The following terms are also used on the image exam and are usually qualified in some fashion in terms of the specific answer requested:
TERM EXAMPLE OF QUALIFICATION
PROGNOSIS for remission, for globe, for life (generally the terms poor, fair, good or excellent should be used here)
OUTCOME most likely, expected, long term, etc.
SIGNIFICANCE for vision, for breeding purposes, for function of eye
THERAPY most appropriate, several possible therapies, generally accepted therapy
DIAGNOSTIC TESTS most appropriate, physical exam, noninvasive, radiographic
IDENTIFY STRUCTURES area generally identified on image
Sample Image Recognition Questions EXAMPLE 1: A series of images show a Siberian Husky with a splotchy pink and black nose, corneal edema, aqueous flare, and a exudative retinal detachment. The question could ask for any or all of the following:
QUESTION APPROPRIATE ANSWER
Clinical Abnormality vitiligo or dermal depigmentation corneal edema aqueous flare retinal detachment
Most likely ocular, clinical diagnosis panuveitis (with secondary ret. detachment)
Most likely etiologic diagnosis VKH-like or uveodermatologic syndrome
Pathogenesis autoimmune destruction of melanocytes
Prognosis for complete resolution poor
EXAMPLE 2: A image shows a horse with a typical "melting" corneal ulcer. The question could ask for:
QUESTION APPROPRIATE ANSWER
Clinical abnormality "melting" corneal ulcer (would also likely accept answers such as "5 mm central corneal ulcer with stromal necrosis," etc.)
Most likely bacterial etiologic agent Pseudomonas aeruginosa
Pathogenesis Collagenolytic, proteolytic destruction of cornea
EXAMPLE 3: A image shows a dog with a dense, black pigmented mass in the posterior chamber, apparently arising from the ciliary body. Questions could include:
QUESTION APPROPRIATE ANSWER
Clinical abnormality black mass in posterior chamber
Most likely histopathologic diagnosis uveal melanoma
Prognosis for patient's life good, (<5% metastasis rate)
Written ExaminationThe Written examination consists of 250 multiple choice questions in eight disciplines: anatomy/embryology, physiology, neuro-ophthalmology, surgery, pharmacology, pathology, medical ophthalmology, and diagnostics. The test is designed to evaluate the candidate's knowledge of both current literature and basic science information relevant to veterinary ophthalmology. The specific content of the questions follows a blueprint (included here) approved by the Examination Committee, detailing discipline, animal species, and region. The exam is given in two sections, 125 questions apiece, and the candidates are given 3.5 hours/section. Also included here are sample examination questions deemed suitable for but not included on the Written examination. These are included here only to act as guidelines as to the types of questions which may be expected.
Attached is a suggested reading list from which examination questions are composed. Appropriate chapters in veterinary medical, surgical, and anatomical, etc., texts should also be consulted. The questions from journal articles are from articles found in the literature (journals cited in the reading list) in the 7 years preceding the time the examination is given, and the candidates should concentrate their study efforts on this more recent scientific literature. However, some articles that are considered "classic" articles (i.e., those that provided a major advancement in the knowledge of that particular condition) and are older than seven years should also be reviewed. A supplemental list of such articles is included. Much of the information from these articles has made its way into contemporary veterinary ophthalmic texts (i.e., Gelatt's textbook), and this information can to some extent be gleaned from these sources; however, the candidates are strongly encouraged to also review the original manuscript.
Note that articles in veterinary journals should be reviewed for any disease, condition, or situation that involves ocular, periocular, or neuro-ophthalmic structures of systemic conditions directly relevant to ocular disease in animals. Review of basic science texts and human clinical journals should be limited to those chapters or articles dealing with situations or diseases directly applicable to veterinary ophthalmology, or to those where a common domestic animals is used as an animal model. Review of human clinical conditions or basic science articles or texts unrelated to veterinary ophthalmology is not necessary for exam preparation. Sample Written Questions
1. Megavoltage x‑radiation of orbital, nasal and paranasal cavity malignant neoplasms in dogs can result in ophthalmic complications. The most common ocular complications include:
a. keratoconjunctivitis sicca, keratitis, conjunctivitis and cataract b. keratoconjunctivitis sicca, anterior uveitis and phthisis bulbi c. keratoconjunctivitis sicca, lens subluxation and glaucoma d. keratoconjunctivitis sicca, globe hypotony and retinal degeneration e. keratoconjunctivitis sicca, retinal hemorrhage and retinal degeneration
2. Which of the following WOULD NOT be a typical finding associated with hypertensive retinopathy in cats?
a. papilledema b. "cotton wool" exudates c. rubeosis iridis d. flame hemorrhages e. hyphema
3. Which of the following statements about applanation tonometers used in the dog is correct based on experimental studies using an anterior chamber manometric technique?
a. the EMT ‑ 20 tonometer overestimates IOP at all pressures tested b. the TON ‑ AIR tonometer tended to underestimate intraocular pressure (IOP) at all manometric levels of pressure c. the Schiotz tonometer consistently gives readings 5‑10 mm Hg below the recorded manometric pressure d. the Mackay‑Marg tonometer exhibits close correlation with manometer pressures up to 40 mm Hg and lower than manometric values above 40 mm Hg e. pneumotomography exhibits close correlation with manometric pressures up to 80 mm Hg
4. Which of the following decreases intraocular pressure by reducing episcleral venous pressure?
a. physostigmine b. epinephrine c. pilocarpine d. dichlorphenamide e. oxygen
5. The inheritance pattern of the rod‑cone dysplasia of Abyssinian cats described by Curtis and Barnett, and characterized by mydriasis, abnormal pupillary light responses and extinguished electroretinograms in 8 to 12 week‑old kittens, is:
a. autosomal recessive b. autosomal dominant c. sex‑linked recessive d. unknown e. sex‑linked dominant
6. A 10 year‑old dog is presented with a fixed, dilated left pupil. The rest of the ophthalmic examination is normal bilaterally. Which of the following would give the most information as to the cause of observed sign and the site of the lesion?
a. apply one (1) drop of 0.5% physostigmine to both eyes and observe the pupils for up to one hour b. apply one (1) drop of 2% pilocarpine to both eyes and observe the pupils for up to one hour c. apply one (1) drop of 0.5% physostigmine to both eyes and observe the pupils for 20 minutes d. apply one (1) drop of 1% hydroxyamphetamine to both eyes and observe the pupils for 30 minutes e. apply one (1) drop of 10% phenylephrine to both eyes and observe the pupils for 30 minutes
7. The retina of the Western‑fenced lizard (Scleroporus occidentalis), like the majority of lizards and snakes, is characterized by which of the following?
a. approximately equal numbers of rods and cones b. deep foveae c. pure rod retina d. pure cone retina e. same retinal thickness at all points
KEY: 1 a 2 c 3 b 4 e 5 b 6 a 7 d
Practical ExaminationThe
practical examination consists of three separate stations that are
designed to evaluate a candidate's proficiency in animal examination
techniques and surgical techniques. Candidates are given
50 minutes for each of the Diagnostic Techniques and Surgery stations
(see below for details). NOTE: All sections of the
practical examination must be passed to successfully complete the
examination. Only a failed section must be repeated. Diagnostic Techniques (Animal Examination)The candidate will have 40 minutes to examine both eyes of 2 clinical patients (i.e.- 20 minutes per patient): a large animal (such as a horse, cow, llama, alpaca or pig) and a small animal (such as a dog, cat, rabbit, rat, or guinea pig). Additionally the candidate will be given up to 5 minutes per patient to set up or adjust any equipment. Time in transit between patients will not be counted against the candidate. All eyes will be dilated with a mydriatic drug and the large animal will have auriculopalpebral nerve blocks performed prior to the candidate’s arrival. Only an ophthalmic examination needs to be performed, not additional diagnostic testing (such as tonometry, tear testing, or fluorescein dye application). Three examiners will be in the examination room with the candidate to record the candidate’s findings and critique the candidate’s examination methods and use of instrumentation. The candidate cannot ask the examiners questions about the animals. Surgery Stations (Extraocular and Intraocular)The two surgery stations (extraocular surgery and intraocular surgery) involve surgical exercises on cadaver (calf, pig, rabbit or other appropriate species) eyes and adnexal structures. Candidates are asked to perform one eyelid procedure, one cornea/conjunctival procedure, and an intraocular procedure. The candidate supplies all necessary instruments, irrigating solution, suture material, blades, gloves, head loupes (if desired), etc. An operating microscope for the intraocular surgery section and stands for organizing the instruments will be available. The Written examination is computer scored and a total score for all 250 questions is generated. The Image Recognition examination is scored independently for each section by three examination committee members in a masked fashion (without knowledge of candidate identity) and their scores averaged. The score for all three sections is used for the final score. The surgery and animal examination stations are evaluated by judges observing and independently scoring the surgical and examination technique of the candidate on separate components of the procedure, including appropriate instrumentation and proficiency in the technique itself. The candidate is asked to explain what is being done during the surgeries and some questions may be asked.
The passing point for the Written and Image Recognition examinations are determined through a criterion referenced method as modified by Angoff. This technique is considered by most experts as one of the most reliable and defensible methods available of setting passing points. It relies on the pooled judgments of content experts. For example, in this approach, a group of experts is asked to judge each item on the test. The criterion used is formed into a question: "what is the probability that a `minimally acceptable' candidate will answer this item correctly?". This question prompts the judges to consider a group of minimally acceptable candidates and what proportion of that group will answer each item correctly. The average of the proportions, or probabilities, is multiplied by the total number of questions in the test. The result then represents the minimally acceptable score. The final passing score for the examination is based on this pooled judgment and includes a statistical adjustment for testing error. This adjustment is provided to give the benefit of the doubt to examinees that score just below the level judged by the content experts to be the minimal passing point. Since the ACVO exams are revised regularly, with some items being replaced by newly developed ones, the content and difficulty level of the examination changes. These changes usually affect the score necessary to pass. As a result, the passing point for each examination is unique. Since the criterion reference method is not feasible to the practical examination grading, the passing point for all three stations has been established at 70%. Candidate Pledge The candidates taking the examination are not to discuss the any portion of the examination, either during or following the examination, with other or future ACVO examination candidates. Any evidence of discussion of the examination during the examination will lead to disqualification of the candidate and initiate a report to the ACVO Ethics and Appeal Committee.
Immediately prior to the examination, the candidates will be required to sign that they have read and agree to the following:
“I hereby acknowledge that the American College of Veterinary Ophthalmologists certification examination is a secure examination duly copyrighted under the laws of the United States of America. I further acknowledge that any reproduction or transmission in any form or by any means of the contents of the questions contained in the examination is strictly prohibited. I understand that reproduction or transmission of the contents of these questions contained in this examination may jeopardize membership in the American College of Veterinary Ophthalmologists. I will not reproduce or transmit any part of this examination without the prior written consent of the American College of Veterinary Ophthalmologists, Board of Regents. On my honor, I have neither given nor received unauthorized aid, directly or indirectly, on the certification examination. I have not observed other candidates receiving unauthorized aid on this examination which has not been reported in writing by me to a Proctor.”
CANDIDATE NOTIFICATION AND REEXAMINATION PROCEDURESThe candidates for the certification examination are notified by the examination committee chairperson by certified mail within 8 weeks of the end of the examination. DO NOT EMAIL OR CALL the Examination Committee Chair. Dr. Hollingsworth WILL NOT give out results over the phone or email to you, your mentor, or anyone else – YOU MUST WAIT FOR THE OFFICIAL CERTIFIED MAIL. The candidates are informed of their specific scores and minimum passing point on the each section of the examination. For the written examination, candidates are notified of their specific scores in each of the components of the exam (e.g., examination domains, etc). For the image recognition exam, the candidates are notified of their specific raw scores on each of the three major domains (Orbit/Adnexa, Anterior Segment, and Lens/Posterior Segment). For the practical examination, the candidates are informed of the percentage score on each of the examination stations.
A candidate need only retake that portion of the examination for which a unsuccessful score was rendered. The portions of the practical examination are considered separate sections as related to reexamination (i.e., only unsuccessful stations need be repeated, not the entire practical examination).
PROCEDURE FOR REAPPLICATION TO REPEAT THE EXAMINATION Reapplicants must comply with all requirements as outlined by the Credentials Committee in order to repeat any portion(s) of the certification examination. Previous satisfaction of Credential Committee requirements does not insure successful reapplication.
APPEAL PROCEDURESCandidate appeal of failing scores on the certification exam can be made to the ACVO Ethics and Appeals Committee within 90 days of the notification of the results by providing written notification to this group. Appeals should be mailed to the Executive Director of the ACVO along with an explanation of the grounds for appeal. The Executive Director will then forward all materials to the Chair of the Ethics and Appeals Committee. The Ethics and Appeals Committee reviews the appeal at either their next scheduled meeting, or by telephone conference, if deemed necessary. Proper policy and procedure for the certification examination by the Examination Committee are the predominant criteria used by the Ethics and Appeals Committee in their deliberation of appeals by candidates and not the specific questions and answers on the examination. The unsuccessful candidate has as a secondary means of restitution, appeal to the American Board of Veterinary Specialists. If you have questions regarding the logistics of the written, image, or practical examinations, you may contact the examination committee chairperson: Dr. Steven R. Hollingsworth Chair, ACVO Examination Committee University of California School of Veterinary Medicine Davis, CA 95616 Office phone: 530-754-7414 Fax: 530-752-0454 |
Examiners for the 2008 ExaminationThe following is a list of the examiners who will be present during the 2008 Examination. If you feel there is ANY possible conflict of interest in having any of these individuals evaluate your performance at the surgical or animal examination stations, please inform the examination committee chair and appropriate adjustments will be made. Mentors are automatically excluded for evaluating their own resident(s). Examples of recognized conflicts would be an individual who is in practice within the same area as a candidate or an individual who was involved in the training of the candidate. Dr. Steve Hollingsworth (Davis, CA) Dr. Stacy Andrew (Atlanta, GA) Dr. Ian Herring (Blacksburg, VA) Dr. Dennis Brooks (Gainesville, FL) Dr. Tim Cutler (West Palm Beach, FL) Dr. Lynne Sandmeyer (Saskatoon, SK) Dr. Gia Klauss (Minnepolis, MN) Dr. Elaine Holt (Caterham, Surrey, UK) Dr. Heidi Denis (Maitland, FL) Dr. Thomas Kern (Ithaca, NY) Dr. Jennifer Urbanz (Phoenix, AZ)
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Schedule
for the 2008 Examination
Hotel/Arrival/Parking The closest major airport to Davis is the Sacramento International Airport (SMF), which is approximately 20-30 minutes from Davis.
There are numerous lodging options in Davis (http://www.DavisVisitor.com/sub_hotels.php?id=9&city=13) and it is the candidate’s responsibility to make hotel arrangements. The closest hotels are in downtown Davis, about 1 mile from the School of Veterinary Medicine.
Parking – A parking pass will be required when parking at the VMTH. Passes can be purchased for $6 from kiosks located in the parking lots. You should plan on parking in lot VP50 or VP55.
Security Passes – Each candidate will need a name badge when in the VMTH. These will be issued to you when you come to room 227 of Vet Med II.
Exam Dates - August 14-16, 2008 at the Vet Med II Building, Room 227, University of California, Davis.
If you have questions regarding the logistics of any portions of the examination, you may notify Dr. Hollingsworth, the Examination Committee Chair. |