- What the Name Actually Means
- Where PEPS Sits in the NBEO Sequence
- Each Word in the Name, Mapped to the Exam
- How the Exam Is Built: Stations, Timing, and Recording
- The Five Weighted Competency Domains
- The Electronic SOAP Note and the Assessment and Plan Entries
- What PEPS Is Not
- Fees, Eligibility, Attempts, and Test-Day Requirements
- Reading the Published Results Carefully
- A Domain-Ordered Preparation Sequence
- Frequently Asked Questions
- PEPS stands for Patient Encounters and Performance Skills, Part III of the NBEO optometry licensure examination sequence.
- The exam has 12 stations: 10 standardized-patient encounters and 2 hands-on clinical-skills stations, with nine encounters scored.
- Results are pass/fail only, with no scaled score, unlike Parts I and II.
- Clinical Assessment and Interpretation carries the largest domain weight at 29%, followed by Management and Documentation at 25%.
What the Name Actually Means
PEPS stands for Patient Encounters and Performance Skills. It is the third part of the entry-to-practice licensure examination series administered by the National Board of Examiners in Optometry (NBEO). If you landed here after searching for the acronym, that is the whole answer: it is an optometry clinical performance examination, taken in person, in which candidates demonstrate that they can actually examine, interpret, manage, and communicate with patients.
The name is unusually literal. "Patient Encounters" refers to the standardized-patient stations where you interact with a trained individual presenting a clinical scenario. "Performance Skills" refers to the hands-on stations where you demonstrate clinical technique. Together they describe a test of what you can do, rather than what you can recall.
Because several unrelated credentials in other fields share the same four letters, it is worth being precise. Everything on this page concerns the NBEO Part III examination for optometry candidates and nothing else. For related definitions, see our short explainers on what PEPS stands for and what PEPS is.
Where PEPS Sits in the NBEO Sequence
PEPS is Part III of the NBEO examination series. Parts I and II are written examinations that report scaled scores. Part III is different in kind: it is a performance assessment, and it is reported as pass or fail without a scaled score. That distinction matters for how you prepare. There is no way to "bank" a strong performance in one area against a weak one in the way a scaled-score exam sometimes allows; you either meet the overall NBEO cut-off or you do not.
PEPS is also an entry-to-practice licensure examination, not a standalone renewable certification. Passing it does not give you a credential that you later renew on a cycle. State licensure maintenance is a separate matter handled by the licensing boards, and no periodic PEPS certificate renewal applies. If you are comparing it to credentials that require continuing-education renewal, our page on PEPS certification explains why that framing does not quite fit.
Each Word in the Name, Mapped to the Exam
The easiest way to understand PEPS is to take the name apart.
Patient Encounters
Ten of the twelve stations are standardized-patient encounters. A standardized patient is a trained person portraying a clinical scenario consistently for every candidate. In these stations you are expected to take a focused history, interpret findings, decide on management, document the encounter in typed form, educate the patient, and communicate appropriately. The encounters are recorded.
One of the ten encounters is an unscored data-collection encounter. That leaves nine scored encounters. You will not be told which one is unscored, so the working assumption must be that every encounter counts.
Performance Skills
Two stations are hands-on clinical-skills stations. These are performance demonstrations of technique rather than conversations. NCCTO supplies the equipment, so you are not bringing your own instruments to the exam; your preparation should focus on fluency with standard technique rather than familiarity with a particular device.
The pairing
The combination is intentional. A candidate can be technically precise and still fail to communicate a plan in plain language, or be warm and articulate and still miss the clinical interpretation. PEPS is designed so that both kinds of weakness show up.
How the Exam Is Built: Stations, Timing, and Recording
PEPS is delivered in person at the National Center of Clinical Testing in Optometry (NCCTO) in Charlotte, North Carolina. It is not a multiple-choice exam. There are no answer bubbles; every station is a performance assessment.
| Feature | PEPS Detail |
|---|---|
| Total stations | 12 |
| Standardized-patient encounters | 10 (one unscored data-collection encounter, nine scored) |
| Hands-on clinical-skills stations | 2 |
| Examination session | 4 hours 30 minutes |
| Per-station timing | 3-minute observation period, then 15-minute station period |
| Breaks | 4-minute breaks, plus a 24-minute extended break after cycle 8 |
| Time on site | Approximately 7 hours including check-in, orientation, and check-out |
| Location | NCCTO, Charlotte, North Carolina |
| Result reporting | Pass/fail, no scaled score |
Plan for the day, not just the exam. Roughly seven hours on site means endurance is part of the test. The structured rhythm of short observation windows followed by fifteen-minute stations rewards candidates who can reset quickly between very different scenarios, and the extended break after cycle 8 is your one real chance to eat, hydrate, and regroup.
The Five Weighted Competency Domains
The NBEO blueprint organizes PEPS around five weighted competency objectives. Note that these are official exam competency objectives, not preparation-curriculum headings, so they describe what is being measured rather than a suggested study syllabus. Our complete guide to the five PEPS content areas goes deeper on each; here is the overview.
| Domain | Weight |
|---|---|
| Clinical Assessment and Interpretation | 29% |
| Management and Documentation | 25% |
| Skills | 22% |
| Patient Education | 13% |
| Communication | 11% |
Clinical Assessment and Interpretation (29%)
The largest domain. It captures whether you can gather a focused history, make sense of findings, and reach sound clinical conclusions within the scenario presented.
- Focused history-taking rather than exhaustive questioning
- Interpreting findings in the context of the presentation
- Reaching defensible assessments under time pressure
Management and Documentation (25%)
The second-largest domain pairs clinical decision-making with the written record of it.
- Choosing appropriate management for the presenting problem
- Producing typed documentation that reflects your reasoning
- Keeping the Assessment and Plan entries consistent with what you did in the room
Skills (22%)
Tied most directly to the two hands-on stations, though clinical technique also appears in the encounters.
- Technique performed fluently with supplied equipment
- Efficient, organized execution inside a fixed time window
Patient Education (13%)
Whether the patient leaves understanding their condition and what happens next.
- Explaining findings in plain, non-jargon language
- Checking understanding and addressing concerns
Communication (11%)
The interpersonal layer that runs beneath every encounter.
- Rapport and professional conduct with the standardized patient
- Clear, organized verbal delivery throughout
One labeling quirk to know: the blueprint table's exact headings control, whereas its prose describes the same areas slightly differently, as Clinical Interpretation and Assessment and as Communication and Professionalism. If you see those variants, they refer to the same weighted areas. Also, the blueprint describes nine clinical-presentation categories as a separate axis, which are not additional competency domains. They tell you the kinds of cases that can appear, whereas the five domains tell you how your performance is judged.
Key Takeaway
Do not treat the 11% Communication domain as a minor add-on. Communication and patient education behave as threads through every encounter, so weakness there can undermine performance in domains that carry far more weight.
The Electronic SOAP Note and the Assessment and Plan Entries
Documentation deserves its own section because it is where candidates most often assume the wrong format. The blueprint describes an electronic SOAP note. The Candidate Guide, however, specifies Assessment and Plan entries. The practical consequence is that your preparation should follow the current electronic documentation workflow described by NBEO rather than a generic paper SOAP template you may have used in school or clinic.
Typed documentation is part of what each encounter assesses. That means two skills run in parallel: you must conduct the encounter, and you must produce a clear written record that matches what you did and concluded. Candidates who practice only the conversation, and rehearse the write-up for the first time on exam day, tend to be surprised by how much attention the documentation component demands. Review the Candidate Guide for the exact workflow and rehearse with it. For a condensed reference, see the PEPS cheat sheet.
What PEPS Is Not
Because the acronym is shared with unrelated credentials in other industries, search results can be confusing. To be unambiguous, here is what the Patient Encounters and Performance Skills (PEPS) examination is, and is not:
- It is the NBEO Part III clinical performance examination for optometry candidates.
- It is not a multiple-choice test; all stations are performance assessments.
- It is not a renewable certification with a periodic renewal cycle.
- It is not scored on a scale; results are pass/fail.
- It is not something you can take on a laptop at home; it is delivered in person at NCCTO in Charlotte.
If you are still sorting out the terminology, our explainers on what PEPS means and what PEPS certification is cover the common points of confusion.
Fees, Eligibility, Attempts, and Test-Day Requirements
Fee
The examination fee is USD 1,490 for administrations beginning August 2026. For a fuller picture of related costs, see the PEPS cost breakdown.
Eligibility
Eligible graduation-year students require institutional confirmation from an ACOE-accredited, accredited-with-conditions, or preliminary-approval program. Eligible accredited-program graduates may also apply, and sponsorship pathways exist for other candidates. The details are in our PEPS requirements guide.
Attempts
You have six attempts, and they combine former CSE and PEPS attempts. Attempts beyond six require NBEO Board committee approval. This is why preparation before the first sitting matters so much: attempts are a finite resource, not just a financial one.
What to bring and what to leave behind
- Professional attire and a white lab coat
- Two current signed IDs, including a government photo ID
- Registered names must match across your IDs and registration
- Outside notes and electronics are excluded from testing areas
Scheduling windows and deadlines are covered in PEPS exam dates.
Reading the Published Results Carefully
Candidates naturally want a pass rate, and two published figures circulate. They are not interchangeable, and neither describes the current-version exam.
| Source | Figure | Population and Period |
|---|---|---|
| Published first-time results | 69.0% | July 1, 2024 to June 30, 2025 administration year |
| NBEO Institutional Yearly Performance Report 2025 | 70.09% (rounded to 70.1% in some school tables) | U.S. first-time Part III CSE/PEPS rate, 1,628 graduates in the October 1, 2024 to September 30, 2025 graduating cohort who attempted all three parts |
These figures use different populations and different periods. Neither is a 2026 or current-version PEPS pass rate, and an ultimate all-parts rate is not a PEPS first-time rate. The sensible reading is qualitative: a substantial share of first-time candidates do pass, and a meaningful share do not, which is consistent with a demanding performance exam. For more on interpreting these numbers, see what the pass-rate data shows, and for the pass/fail mechanics, the passing score explainer. If you want a sense of difficulty, how hard the PEPS exam is addresses it directly.
A Domain-Ordered Preparation Sequence
Because this guide is about meaning rather than methodology, here is a single, PEPS-specific sequencing idea rather than a generic study framework. Order your preparation by how the exam's weights and dependencies interact, and revisit documentation throughout rather than saving it for the end. A fuller plan is in the PEPS study guide, and the PEPS training page covers preparation resources.
Clinical Assessment and Interpretation
- Start with the heaviest domain at 29%, since everything else builds on sound clinical reasoning
- Practice focused history-taking against the nine clinical-presentation categories
Management and Documentation
- Rehearse the current electronic documentation workflow with Assessment and Plan entries
- Make your typed record consistent with your in-room reasoning
Skills
- Drill hands-on technique within fixed time limits
- Aim for fluent, organized execution with standard equipment
Patient Education and Communication
- Practice explaining findings in plain language
- Run full-length mock cycles that combine every domain under timed conditions
Write-ups and conversations should be practiced together from the start. When you are ready to pressure-test yourself, the practice resources on our main practice test site can help you check your readiness before you commit to a sitting.
Frequently Asked Questions
PEPS stands for Patient Encounters and Performance Skills. It is Part III of the NBEO optometry licensure examination series, a performance assessment delivered in person rather than a written test.
No. PEPS is an entry-to-practice licensure examination, not a standalone renewable certification. State licensure maintenance is separate, and no periodic PEPS certificate renewal applies.
There are 12 stations: 10 standardized-patient encounters and two hands-on clinical-skills stations. One encounter is an unscored data-collection encounter, leaving nine scored encounters plus the two skills stations.
No. PEPS is reported pass/fail without a scaled score, unlike Parts I and II. Passing requires meeting the overall NBEO cut-off.
The fee is USD 1,490 for administrations beginning August 2026. You have six attempts, which combine former CSE and PEPS attempts, and attempts beyond six require NBEO Board committee approval.
Understanding the meaning of the name is the first step; the rest is deliberate, domain-by-domain practice. For career context after you pass, you can explore PEPS jobs and the salary guide, and for another phrasing of the basic question, see what is a PEPS or the companion PEPS meaning overview.