- PAM is NBEO Part II: 350 questions in two sessions of 175, delivered through Pearson VUE in one day.
- Normal Health / Disease / Trauma carries 60-70% of content, so most training time belongs there.
- Treatment / Management is the heaviest task dimension at 40-57%, ahead of Diagnosis at 26-34%.
- Session 1 cannot be revisited after the break, so train for commitment and pacing within each session.
PAM Training: Preparing for the NBEO Part II Patient Assessment and Management Exam
- PAM Training: Preparing for the NBEO Part II Exam
- What You Are Actually Training For
- Training for the Format: 350 Items in One Day
- Training by Domain
- The Embedded TMOD Items
- Training Across the Matrix Dimensions
- Choosing Training Resources
- Sequencing Your Training Weeks
- Registration, Fees and Test-Day Logistics
- Training Toward the Score Scale
- Frequently Asked Questions
Key Takeaways
- PAM is NBEO Part II: 350 questions in two sessions of 175, delivered through Pearson VUE in one day.
- Normal Health / Disease / Trauma carries 60-70% of content, so most training time belongs there.
- Treatment / Management is the heaviest task dimension at 40-57%, ahead of Diagnosis at 26-34%.
- Session 1 cannot be revisited after the break, so train for commitment and pacing within each session.
- NBEO scores run 100-900 and scores above 300 pass; the exam fee is $1,490 for August 2026 administrations.
"PAM training" can mean different things depending on who is asking. On this site it refers to one thing: preparing for the Patient Assessment and Management examination, Part II of the National Board of Examiners in Optometry (NBEO) sequence. This article lays out what that training should look like, grounded in the exam's published structure rather than generic test-prep advice. If you are still orienting yourself, start with What Is PAM? and then return here.
What You Are Actually Training For
Part II PAM is the full entry-to-profession licensure examination for the patient-care side of optometry. It is not standalone TMOD, not Part III PEPS, and not an independent board certification. That distinction matters for training: you are not preparing for a narrow specialty credential but for a broad clinical examination that samples the whole scope of primary eye care.
Because PAM is a licensure examination result rather than a renewable specialty certification, your training goal is simple to state: demonstrate entry-level clinical judgment across assessment, diagnosis and management. NBEO states that scores do not expire, though individual licensing boards may attach their own acceptance conditions. For a deeper look at the credential's nature, see What Is PAM Certification?
Training for the Format: 350 Items in One Day
The structure of the exam should shape how you practice. Part II contains 350 questions delivered in two sessions of 175. Total testing time is seven hours in one day, split into two 3.5-hour sessions. The morning session includes an additional 15 minutes for the tutorial and non-disclosure agreement, and an optional break of up to 45 minutes separates the sessions. Those additions are not question-timer minutes.
Case-based items
Image-intensive patient cases generally carry three to six associated items, with three to ten response options per item. You will be reading a clinical scenario, interpreting images such as fundus photographs, anterior segment views or other clinical findings, and then answering several linked questions. Train with case sets rather than isolated flashcards, because the exam rewards carrying a thread of reasoning across multiple questions.
Single-answer and multiple-response questions
Both formats appear. On multiple-response items, up to four correct selections can be required, and credit requires all and only the correct options. There is no partial credit for getting three of four. Practice committing to a complete answer set, and practice recognizing when an option is plausible but not best.
One-way progress between sessions
Session 1 cannot be revisited after the inter-session break, and unscheduled breaks do not stop the clock. Train accordingly: build the habit of making a final decision on each item and flagging only what genuinely merits a return visit within the same session.
| Format element | What it means for training |
|---|---|
| 350 questions, 2 sessions of 175 | Rehearse 175-item blocks, not just short quizzes |
| Two 3.5-hour sessions, one day | Build stamina for a full seven testing hours |
| Case sets of 3-6 items | Practice linked reasoning from a single presentation |
| 3-10 response options | Practice eliminating distractors in long option lists |
| Multiple-response, up to 4 correct | All-and-only scoring; commit to complete answers |
| No return to Session 1 | Finalize decisions before the break |
Training by Domain
The Part II content outline has two top-level condition and content areas. Allocate time in proportion to their weight, then adjust for your personal weak spots. The full breakdown is in PAM Exam Domains 2026: Complete Guide to All 2 Content Areas; here is how it translates into a training plan.
Domain 1: Refractive / Sensory Processes / Oculomotor Processes (30-40%)
This area covers the functional visual system: how light is focused, how the eyes work together, and how the brain processes what they report. Candidates need to move fluently between findings and management decisions.
- Refractive conditions and their correction and management
- Sensory processing and visual function considerations
- Accommodative / Vergence / Oculomotor Anomalies (the outline's wording, which controls over the matrix's slightly different phrasing)
- Interpreting binocular vision findings and deciding on appropriate intervention
Domain 2: Normal Health / Disease / Trauma (60-70%)
The larger area and the one that deserves the majority of your hours. It spans normal ocular health, ocular and systemic disease, and traumatic presentations across the anterior and posterior segments and adnexa.
- Recognizing normal versus abnormal findings in clinical images
- Differential diagnosis from history, signs and symptoms
- Selecting appropriate testing, treatment, referral or co-management
- Trauma assessment and the urgency decisions that follow
Key Takeaway
Because Domain 2 holds 60-70% of the content, a candidate who spends equal time on both areas is under-training the larger one. Weight your calendar roughly in line with the published ranges, then add extra hours where practice results show gaps.
The Embedded TMOD Items
Approximately 120 TMOD items are embedded within the 350 questions, not added on top. NBEO describes the count as approximate in the outline and program description, so treat 120 as a guide rather than an exact guarantee. These items relate to ocular disease management and are woven into the exam rather than segregated.
Two points matter for training. First, overall PAM and TMOD carry separate pass/fail decisions, so strength in one does not automatically rescue the other. Second, standalone TMOD is a separate registration pathway and is not the selected full PAM examination, so do not confuse the two when planning. Because TMOD content overlaps heavily with the disease and treatment material in Domain 2, your disease-management training pulls double duty.
Training Across the Matrix Dimensions
A separate content matrix cross-classifies the exam by the kind of task a question asks of you. These are intersecting dimensions, not four extra additive domains, and the ranges should be read as published without normalizing them to total 100.
| Task dimension | Published range | Training emphasis |
|---|---|---|
| Clinical Correlation of Basic Science Principles | 11-17% | Link anatomy, physiology, pharmacology and pathophysiology to clinical findings |
| Diagnosis | 26-34% | Build differentials from history, signs and testing |
| Treatment / Management | 40-57% | Choose therapy, follow-up, referral and co-management |
| Legal Issues / Ethics / Public Health | 4-10% | Scope-of-practice, consent, reporting and population-health reasoning |
Clinical presentation (history, signs, symptoms) has no separate percentage; it is assessed within the cases themselves. The practical message is that Treatment / Management is the largest task type, so do not stop your reasoning at "what is it?" Always push to "what do I do now, and what do I tell the patient?" For a sense of how this affects overall challenge, read How Hard Is the PAM Exam? Complete Difficulty Guide 2026.
Tools you can use on test day
The exam is closed-book. An on-screen basic calculator, a searchable generic/trade drug equivalence list, an abbreviation list and a supplied scratch booklet are available. The drug list is a convenience for matching names, not an exhaustive syllabus, so you still need to know therapeutic classes, indications and cautions before test day. Practice using the calculator and the lookup tools if your prep platform simulates them, so the interface does not slow you down.
Choosing Training Resources
NBEO offers an optional Part II PAM/TMOD Practice Databank containing NBEO-owned questions, administered by Test Run, an independent third-party organization. It costs $199 for one month, with a $149 additional-month renewal subject to examination-registration and administration-date conditions. These are preparation charges, separate from the examination fee. Purchasing or completing the databank does not guarantee a pass.
Beyond the official databank, candidates commonly use review books, lecture-based courses and commercial question banks. We have not accessed paid third-party content, so we cannot vouch for any specific product. Evaluate resources against the published outline and matrix: does the material emphasize disease and management, use image-based cases, and include multiple-response items?
For practice at scale, you can work through questions on our main practice test site, and pair them with the PAM Study Guide 2026: How to Pass on Your First Attempt for a structured plan.
Sequencing Your Training Weeks
Generic scheduling advice is easy to find; what matters here is mapping weeks to the exam's actual weighting. The timeline below is a template to adapt, not a fixed prescription, and the right length depends on your starting point and calendar.
Baseline and blueprint
- Read the current content outline and matrix end to end
- Take a diagnostic block to find weak areas by domain
- Review Domain 1 fundamentals if refractive or binocular vision is a weak area
Domain 2 heavy lift
- Systematic pass through anterior and posterior segment disease, trauma and systemic correlates
- Emphasize treatment and management decisions, not just diagnosis
- Work case sets of linked items
Domain 1 consolidation and integration
- Accommodative, vergence and oculomotor management scenarios
- Mixed-domain blocks to practice switching topics
- Review legal, ethics and public health material
Endurance and simulation
- Full-length timed sessions of 175 items to rehearse pacing
- Practice committing to answers without relying on revisiting
- Light review of weak areas rather than new material in the last days
A one-page PAM cheat sheet is useful for last-week review, but build it from your own error log rather than copying someone else's.
Registration, Fees and Test-Day Logistics
Training includes the administrative side. You register and pay through NBEO, then schedule your appointment with Pearson VUE. Testing centers are located across the USA, Puerto Rico and Canada. The fee for administrations beginning August 2026 is $1,490, and late registration adds $400. For a full pricing picture, including preparation costs, see PAM Certification Cost 2026: Complete Pricing Breakdown, and for scheduling timing see PAM Exam Dates 2026: Testing Windows, Deadlines & Scheduling.
Eligibility
Student eligibility begins in the academic year of graduation from an ACOE program with Accredited, Accredited with Conditions or Preliminary Approval status, with institutional confirmation. Graduates of Accredited or Accredited with Conditions programs are eligible. Other candidates require direct sponsorship from a qualifying optometric program or a state optometry licensure board. Details are in PAM Requirements 2026: Eligibility, Prerequisites & How to Qualify.
Identification and attempts
Bring two current signed physical IDs, at least one a government photo ID, with names matching your registration. After six attempts, special approval or remediation is required. NBEO does not permit superscoring, so each attempt stands on its own. Treat your first attempt as the one you intend to pass, and use your training to make that realistic.
Training Toward the Score Scale
NBEO reports scores on a 100-900 scale and states that scores above 300 pass. That is the exact boundary wording to hold onto; do not translate it into a raw percentage of questions answered correctly. Scores are equated across forms rather than curved, which means a difficult form and an easier form are adjusted so that the same underlying ability yields a comparable score. The practical implication is that you cannot game the exam by guessing which version you will get; you simply need to know the material. More detail is in PAM Passing Score 2026: Exactly What You Need to Pass.
Reading the pass-rate numbers carefully
Published figures cover different populations, so do not blend them. UC Berkeley and Ferris State both report an 89.4% national first-time Part II PAM pass rate for academic year 2025-2026 (September 1-August 31); these are university publications of NBEO outcomes, and their first-time population includes candidates regardless of graduation status. Separately, NBEO's Institutional Yearly Performance Report for October 1, 2024-September 30, 2025, hosted by ASCO, reports an 87.96% Part II first-time pass rate for a cohort of 1,628 qualifying U.S. graduates who attempted all three NBEO parts. These cover different groups and periods and should not be pooled into a trend. For context, see PAM Pass Rate 2026: What the Data Shows.
Key Takeaway
High published first-time pass rates reflect well-prepared cohorts, not an easy exam. Treat them as a reason for confidence in structured training, not as permission to under-prepare.
Frequently Asked Questions
It means preparing for the NBEO Part II Patient Assessment and Management exam: studying both content areas, practicing image-based case sets and multiple-response items, and rehearsing the 350-question, two-session format.
Normal Health / Disease / Trauma holds 60-70% of the content and Refractive / Sensory Processes / Oculomotor Processes holds 30-40%, so weight your hours accordingly and adjust for your own weak areas.
NBEO's optional databank offers NBEO-owned questions through Test Run, but NBEO notes that purchase or completion does not guarantee passing. Most candidates combine it with content review and broader practice.
No. Session 1 cannot be revisited after the inter-session break, and unscheduled breaks do not stop the clock, so train yourself to finalize answers within each session.
PAM is a licensure examination result, so passing supports entry to practice. For career context, see PAM Jobs and Is the PAM Certification Worth It? Complete ROI Analysis 2026.
Solid PAM training mirrors the exam itself: heavy on disease and management, fluent with case-based images, and rehearsed for a full seven-hour day. Start from the official outline, build a plan weighted to the published ranges, and use the practice test platform to turn that plan into measurable progress.