- What a PEPS Actually Is
- Who Runs It and Where It Happens
- Inside the 12-Station Format
- How the Testing Day Unfolds
- The Five Competency Domains
- Scoring, Pass/Fail Reporting, and Published Results
- Eligibility, Attempts, and Fees
- What You Must Bring and What You Cannot
- Why It Is Not a Renewable Certification
- Sequencing Preparation by Domain
- Frequently Asked Questions
- PEPS is Part III of the National Board of Examiners in Optometry (NBEO) sequence, an entry-to-practice licensure exam.
- The exam has 12 stations: 10 standardized-patient encounters and two hands-on clinical-skills stations.
- Nine encounters are scored; one encounter is unscored data collection.
- Clinical Assessment and Interpretation carries the most weight at 29% of the blueprint.
What a PEPS Actually Is
In optometry, PEPS stands for Patient Encounters and Performance Skills. It is Part III of the National Board of Examiners in Optometry (NBEO) examination sequence, and it is a live, in-person performance assessment rather than a written test. If you have seen the acronym elsewhere and wondered which credential this is, the short version is that this page covers only the optometry licensure exam. For other phrasings of the same question, see our explainers on what PEPS is, what PEPS stands for, and the meaning of PEPS.
The exam asks a simple question with a demanding answer: can you safely and competently handle a patient visit from start to finish? Instead of selecting answers on a screen, you interview standardized patients, make clinical decisions, perform hands-on skills, explain your reasoning in plain language, and document the visit electronically. Every one of those behaviors is observed.
Who Runs It and Where It Happens
NBEO administers the exam in person at the National Center of Clinical Testing in Optometry (NCCTO) in Charlotte, North Carolina. The center supplies the equipment, so candidates are not hauling their own instruments across the country. That also means your preparation should include getting comfortable with unfamiliar instruments and a testing environment you cannot customize.
PEPS is an entry-to-practice licensure examination. It sits alongside the earlier parts of the NBEO sequence, but its format is entirely different. Parts I and II report scaled scores, while PEPS is reported as pass/fail. Our article on the PEPS passing score goes deeper on how that outcome is determined.
Inside the 12-Station Format
The performance format consists of 12 stations:
- 10 standardized-patient encounters, in which trained actors present clinical scenarios
- Two hands-on clinical-skills stations, in which you demonstrate technical competence
One of the 10 encounters is unscored data collection. That leaves nine scored encounters plus the two skills stations. Because you will not know which encounter is the unscored one, treat every patient as if the outcome counts.
What the encounters assess
Each standardized-patient encounter is recorded and evaluates a defined set of abilities:
- Focused history-taking
- Clinical interpretation
- Management decisions
- Typed documentation
- Patient education and communication
Notice how much of that list is not purely clinical knowledge. A candidate who reaches the correct diagnosis but rambles through the history, skips an explanation, or writes a muddled note can still lose ground.
The electronic documentation piece
The blueprint describes an electronic SOAP note, and the Candidate Guide specifies Assessment and Plan entries. In practice, that means you should rehearse the current electronic documentation workflow rather than assume a generic paper SOAP template will transfer neatly. Practice typing concise, accurate entries under time pressure, because documentation is evaluated as its own skill.
How the Testing Day Unfolds
The examination session itself runs 4 hours 30 minutes. Each station follows the same rhythm: a 3-minute observation period followed by a 15-minute station period. Short 4-minute breaks are built in, and there is a 24-minute extended break after cycle 8.
Plan on roughly 7 hours on site once you include check-in, orientation, and check-out. That is a long day of sustained concentration, so pacing and energy matter more than many candidates expect.
| Element | Detail |
|---|---|
| Total stations | 12 |
| Standardized-patient encounters | 10 (one unscored data-collection encounter) |
| Hands-on skills stations | 2 |
| Scored encounters | 9 |
| Observation period per station | 3 minutes |
| Station period | 15 minutes |
| Short breaks | 4 minutes |
| Extended break | 24 minutes, after cycle 8 |
| Exam session length | 4 hours 30 minutes |
| Approximate time on site | About 7 hours |
The Five Competency Domains
The blueprint organizes what the exam measures into five weighted competency objectives. These are official exam objectives, not chapter headings from a prep curriculum, so use them to judge where your preparation hours should go.
Domain 1: Clinical Assessment and Interpretation (29%)
The largest domain. It covers gathering findings, interpreting them, and reaching sound clinical conclusions across the range of presentations.
- Focused history that targets the presenting complaint
- Interpreting findings and forming an assessment
- Recognizing urgency and what must not be missed
Domain 2: Management and Documentation (25%)
Turning an assessment into a plan, then recording it accurately in the electronic note.
- Appropriate management and follow-up decisions
- Clear, complete Assessment and Plan entries
- Typed documentation completed within the time limits
Domain 3: Skills (22%)
Hands-on technical competence, demonstrated at the clinical-skills stations using NCCTO equipment.
- Correct, efficient technique
- Comfort with equipment you did not bring
- Safe, patient-aware handling
Domain 4: Patient Education (13%)
Explaining conditions, findings, and next steps in language a patient can follow and act on.
- Plain-language explanations
- Checking that the patient understood
Domain 5: Communication (11%)
The interpersonal side of the encounter, including how you listen, respond, and conduct yourself.
- Rapport and professionalism
- Responding to the patient's concerns
One detail worth knowing: the blueprint table's exact headings control the domain names, while its prose uses slightly different wording (Clinical Interpretation and Assessment, and Communication and Professionalism). Separately, the blueprint contains nine clinical-presentation categories. Those are a different axis from the competency domains, not extra domains, so do not count them as a sixth through fourteenth content area. For a full walkthrough, read our guide to all five PEPS content areas.
Scoring, Pass/Fail Reporting, and Published Results
Passing requires meeting the overall NBEO cut-off. PEPS is reported pass/fail without a scaled score, which is a real change from Parts I and II. You will not receive a numeric score to compare against peers or to diagnose a narrow miss.
What the published numbers say, and what they do not
Two separate statistics circulate, and they should not be blended:
- Published first-time results for the July 1, 2024 to June 30, 2025 administration year report 69.0%.
- The NBEO Institutional Yearly Performance Report 2025 reports a 70.09% U.S. first-time Part III rate (rounded to 70.1% in some school tables) for 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. Treat them as context, not prediction. We unpack the details in our article on the PEPS pass rate, and for a realistic sense of difficulty, see how hard the PEPS exam is.
Eligibility, Attempts, and Fees
Who can sit for it
Eligible graduation-year students need 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 full list of conditions is in our breakdown of PEPS requirements.
Attempt limits
Six attempts combine former CSE and PEPS attempts. Attempts beyond six require NBEO Board committee approval. If you previously attempted the former CSE, those tries count against the same total, so check your history before planning around a retake.
Fee
The fee is USD 1,490 for administrations beginning August 2026. Travel to Charlotte and any time off work come on top of that, so budget accordingly. Our PEPS cost breakdown covers the full picture, and you can confirm scheduling windows in our guide to PEPS exam dates.
What You Must Bring and What You Cannot
Test-day logistics are strict, and a preventable problem at check-in is an awful way to start a long day.
- Professional attire and a white lab coat
- Two current, signed IDs, including a government photo ID
- Name match: the name on your IDs must match your registered name
Outside notes and electronics are excluded from testing areas, and NCCTO supplies the equipment. Do not plan on relying on a personal device for last-minute review once you are in the testing area.
Why It Is Not a Renewable Certification
Many people search for "PEPS certification," but the exam is better understood as a licensure gateway than a credential you hold and renew. It is an entry-to-practice licensure examination, not a standalone renewable certification. No periodic PEPS certificate renewal applies. State licensure maintenance is a separate matter handled by your state board. If you need to verify an exam result, NBEO maintains a credentialing verification page at nbeo.org/credentialing.
That framing affects how you think about value. Passing PEPS opens a door to licensure and practice rather than adding a line item you must keep alive. For questions about career outcomes, see our discussion of whether the PEPS is worth it, and for more on terminology, our pages on what PEPS certification means and PEPS certification clear up common confusion.
Sequencing Preparation by Domain
Rather than a generic study calendar, let the blueprint weights and the structure of the exam decide your order. The timeline below is one reasonable way to do that over four weeks; stretch or compress it to fit your situation.
Clinical Assessment and Interpretation (29%)
- Drill focused histories for common presentations
- Practice stating an assessment out loud, with reasoning
- Review urgent versus routine decision points
Management and Documentation (25%)
- Write Assessment and Plan entries against a clock
- Follow the current electronic workflow, not a paper template
- Pair each assessment with a defensible plan and follow-up
Skills (22%)
- Rehearse techniques until they are smooth and efficient
- Practice with unfamiliar equipment to reduce surprises
- Narrate what you are doing for the observer
Patient Education and Communication (13% and 11%)
- Explain findings in plain language to a non-clinician
- Run full timed mock stations that combine every domain
- Practice the 3-minute observation plus 15-minute station rhythm
The logic here is that Domain 1 underpins everything else, since you cannot manage or explain what you have not correctly assessed. Communication and education come last because they improve fastest through full run-throughs that weave all five domains together. For a fuller plan, see our PEPS study guide, and for a quick refresher near test day, the PEPS cheat sheet. Structured PEPS training can also help you rehearse the encounter format, and you can pressure-test your readiness with practice on our main practice test site.
Key Takeaway
Practice in the exam's own rhythm: roughly 3 minutes to observe, then 15 minutes to interview, examine, decide, educate, and document. Candidates who only study content often run out of time on documentation.
Frequently Asked Questions
PEPS stands for Patient Encounters and Performance Skills. It is Part III of the NBEO examination sequence and is an in-person performance assessment of clinical competence for entry-to-practice licensure.
There are 12 stations: 10 standardized-patient encounters and two hands-on clinical-skills stations. One encounter is unscored data collection, 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 examination session lasts 4 hours 30 minutes, with each station using a 3-minute observation period and a 15-minute station period. Allow approximately 7 hours on site including check-in, orientation, and check-out.
No. PEPS is an entry-to-practice licensure exam, not a renewable certification, and no periodic PEPS certificate renewal applies. State licensure maintenance is separate and handled through your state board.
Passing PEPS contributes to licensure eligibility rather than guaranteeing a particular position. Our articles on PEPS jobs and the PEPS salary guide discuss career pathways in more detail.