- What PEPS Actually Is (and Isn't)
- Who Runs the Exam and Where
- Inside the 12-Station Format
- The Five Weighted Domains
- Clinical Presentation Categories: A Separate Axis
- Eligibility, Fees, and Attempt Limits
- Exam Day Logistics
- Scoring and Published Results
- Sequencing Your Preparation by Domain
- Frequently Asked Questions
- PEPS is Part III of the NBEO optometry licensure sequence: a performance exam, not a renewable certification.
- 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 is the heaviest domain at 29%.
What PEPS Actually Is (and Isn't)
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 an entry-to-practice licensure examination for optometry candidates. If you searched for "PEPS certification" expecting a credential you earn once and renew every few years, the reality is different: PEPS is a one-time hurdle on the path to licensure, and there is no periodic PEPS certificate renewal. State licensure maintenance is a separate matter handled by your licensing board.
The most important thing to understand is that PEPS is a performance assessment. You are not selecting answers from a list. You are interviewing standardized patients, performing clinical skills, interpreting findings, documenting in an electronic note, and explaining your plan to the patient, all while being recorded. For a broader orientation to the acronym itself, see our explainers on what PEPS is and what PEPS stands for.
Who Runs the Exam and Where
The NBEO develops and administers PEPS. The in-person assessment takes place at the National Center of Clinical Testing in Optometry (NCCTO) in Charlotte, North Carolina. Because the center supplies the clinical equipment, candidates do not haul their own instruments across the country; your job is to arrive prepared to use standardized equipment efficiently and confidently.
The current blueprint and candidate guide cover the August 2026 through May 2027 administration window. Candidates should always treat the NBEO's published documents as the controlling source, since exam details can be revised between administration periods. For scheduling specifics, our guide to PEPS exam dates and testing windows is a useful companion.
Inside the 12-Station Format
The exam consists of 12 stations:
- 10 standardized-patient encounters, where you work with trained actors presenting clinical scenarios.
- Two hands-on clinical-skills stations, where you demonstrate technique directly.
One of the ten encounters is unscored data collection, which leaves nine scored encounters plus the two skills stations. You will not be told which encounter is the unscored one, so treat every patient as if it counts.
What the encounters evaluate
Across the encounters, examiners assess:
- Focused history-taking
- Clinical interpretation of findings
- Management decisions
- Typed documentation
- Patient education and communication
Encounters are recorded, which means your communication style and professionalism are part of the permanent record of your performance.
Timing and pacing
The examination session runs 4 hours 30 minutes. Each station includes a 3-minute observation period followed by a 15-minute station period. Candidates receive 4-minute breaks between stations at set points and a 24-minute extended break after cycle 8. Once you factor in check-in, orientation, and check-out, plan on roughly 7 hours on site.
| Format Element | PEPS Detail |
|---|---|
| Total stations | 12 (10 encounters + 2 skills stations) |
| Scored encounters | 9 (one encounter is unscored data collection) |
| Observation period | 3 minutes per station |
| Station period | 15 minutes per station |
| Extended break | 24 minutes after cycle 8 |
| Session length | 4 hours 30 minutes |
| Time on site (approx.) | About 7 hours |
| Question style | Performance stations, not multiple-choice |
The Five Weighted Domains
The NBEO blueprint lists five weighted competency lines. These are official exam competency objectives, not headings in a preparation curriculum, so use them to understand what is being scored rather than as a syllabus. Note that the blueprint table's exact headings control; its prose uses slightly different phrasing (Clinical Interpretation and Assessment, and Communication and Professionalism), which can cause confusion when reading the document.
| Domain | Weight |
|---|---|
| Clinical Assessment and Interpretation | 29% |
| Management and Documentation | 25% |
| Skills | 22% |
| Patient Education | 13% |
| Communication | 11% |
Domain 1: Clinical Assessment and Interpretation (29%)
The largest slice of the exam. This is where you turn history and findings into a sound clinical picture.
- Gather a focused history rather than a exhaustive one
- Interpret findings accurately and connect them to a working assessment
- Recognize which presentations call for urgency versus routine follow-up
Domain 2: Management and Documentation (25%)
Your plan and your written record of it.
- Select appropriate management for the clinical scenario
- Record Assessment and Plan entries in the electronic note
- Keep documentation clear, complete, and consistent with what you told the patient
Domain 3: Skills (22%)
The hands-on demonstrations at the two clinical-skills stations.
- Perform technique correctly and efficiently with NCCTO-supplied equipment
- Narrate or sequence steps in a way that reflects sound clinical practice
- Practice until instrument handling is automatic
Domain 4: Patient Education (13%)
Explaining the condition, the plan, and what happens next in plain language.
Domain 5: Communication (11%)
Rapport, professionalism, and how you conduct the encounter from greeting to close.
For a deeper domain-by-domain walkthrough, read our complete guide to all five PEPS content areas.
Clinical Presentation Categories: A Separate Axis
Beyond the five competency domains, the blueprint organizes encounters by nine clinical-presentation categories. This is a separate axis of the blueprint, not additional competency domains. In practice, think of it as a grid: the domains describe what skills are being evaluated, while the presentation categories describe what kind of patient problem you might be handling when those skills are on display. Candidates who confuse the two sometimes try to study "nine more domains," which misreads the blueprint.
Key Takeaway
Read the blueprint as two overlapping lenses: five weighted competencies and nine presentation categories. Prepare so that every competency is solid across any presentation you might draw.
Eligibility, Fees, and Attempt Limits
Who can sit for PEPS
Eligible graduation-year students need institutional confirmation from an ACOE-accredited, accredited-with-conditions, or preliminary-approval program. Eligible graduates of accredited programs may also apply, and sponsorship pathways exist for other candidates. Our PEPS requirements guide goes through eligibility and prerequisites in detail.
Cost
The exam fee is USD 1,490 for administrations beginning August 2026. That figure covers the exam itself and does not include travel to Charlotte or lodging. See our PEPS cost breakdown for budgeting around the full trip.
Attempt limits
Candidates have six attempts, and these combine former CSE and PEPS attempts. Attempts beyond six require NBEO Board committee approval. Because former CSE attempts count toward the total, anyone who tested under the older format should confirm their remaining attempts before registering.
Exam Day Logistics
Arrive ready for a long, structured day. Requirements include:
- Professional attire
- A white lab coat
- Two current signed IDs, including a government photo ID
- A registered name that matches your IDs exactly
Outside notes and electronics are excluded from testing areas, so there is no last-minute cramming between stations. NCCTO provides the equipment you will use. Name mismatches between registration and ID are a preventable problem; verify yours well before the trip.
Scoring and Published Results
Passing requires meeting the overall NBEO cut-off. PEPS is reported pass/fail without a scaled score, which is a notable difference from Parts I and II. That means you will not receive a number to benchmark against peers. For details on what the cut-off means in practice, see our guide to the PEPS passing score.
Reading the pass-rate data carefully
Two published figures circulate, and they measure different things:
- 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 CSE/PEPS 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.
Sequencing Your Preparation by Domain
Because PEPS rewards integrated performance, a good plan builds the domains in an order that compounds. One workable sequence, weighted by the blueprint:
Skills first, because they need physical repetition
- Drill the hands-on techniques until sequencing is automatic
- Skills carries 22% and cannot be crammed the week before
Clinical Assessment and Interpretation (29%)
- Run timed mock encounters across varied presentations
- Practice stopping at a focused history rather than a complete one
Management and Documentation (25%)
- Type Assessment and Plan entries under the 15-minute clock
- Check that your note matches what you told the patient
Patient Education and Communication (24% combined)
- Record yourself explaining a diagnosis in plain language
- Run full 12-station simulations to build stamina for the seven-hour day
For a fuller plan, see our PEPS study guide and the one-page PEPS cheat sheet for quick review. If you want to test your readiness against exam-style content, you can try the PEPS practice tests and explore the rest of the PEPS Exam Prep resources.
Frequently Asked Questions
No. PEPS is Part III of the NBEO examination sequence and functions as an entry-to-practice licensure exam. There is no periodic PEPS certificate renewal. State licensure maintenance is handled separately by your licensing board.
No. PEPS consists of 12 performance stations: 10 standardized-patient encounters and two hands-on clinical-skills stations. You interview patients, perform skills, document electronically, and educate patients.
The fee is USD 1,490 for administrations beginning August 2026. Travel and lodging for testing in Charlotte, North Carolina are additional.
You have six attempts, and former CSE attempts count toward that total. Attempts beyond six require NBEO Board committee approval.
PEPS is reported pass/fail without a scaled score, unlike Parts I and II. Passing requires meeting the overall NBEO cut-off.
Whatever your timeline, treat the NBEO's current blueprint and Candidate Guide as the final word, and let the exam's performance format shape how you practice: out loud, under time, and with the same electronic workflow you will see in Charlotte.