1. Study SmarterTM Effective Study Strategies for the PAVE Qualifying Exam (QE)
Steven I McLaughlin DVM, MPH, DACVPM

2. “It is not enough to be a good chess player, you must also play well.” -Savielly Tartakower

3. A Story
Once upon a time, there was a world called veterinary medicine,
covered in many forests.
One forest was called “Pharmacology”; another “Physiology” and
so on.
In the Pharmacology forest, there were many trees. One tree
was called “Antibiotics” and another called “Antiparasitics”.
On that antibiotics tree was a single leaf called “Rifampin”
One day, a good-hearted but near-sighted
vet student wandered into the pharmacology
forest, and got so engrossed studying a leaf
on a single tree that she got lost, and a big
bad wolf called PAVE QE came and ate her The End

4. The need for speed It is time to go fast, people.
The goal is not to know everything
The goal is not to get every question right
The goal is to pass
In the forests of knowledge, let this be your map

5. QE structure, pass rates Study strategies for QE
Today’s talk: Program for the Assessment of Veterinary Education Equivalence Qualifying Exam (PAVE QE)
QE structure, pass rates
Study strategies for QE
Test-taking strategies for QE

6. QE Structure 300 questions, takes all day Two 150-question blocks
165 minutes per block (almost 3 hours!)
~1 minute per question
10% of questions have images
Typically, questions not counted during scoring
Breaks
No break once you start a block
45 minute break between blocks
If finish block early, get extra break time

7. Pop Quiz
What percentage of students taking QE for the first time pass ?
(A) 58%
(B) 69%
(C) 70%
(D) 78%
(E) 89%
70% (212/303) of candidates taking QE for the first time PASSED on the Sep 07’ Jan, May 08’ test dates.
PAVE QE Technical Report, (most recent data available as of 24 July, 2009)
For other years, see QE technical Reports webpage

8. QE Pass Rates and Trends
Took QE
Sep 05’, Jan, May 06’
299 (all) 270 (1st attempt)
Sep 07’, Jan, May 08’
(all)
303 (1st attempt)
Pass (%)
230 (77%)
216 (80%)
252 (63%)
212 (70%)
Take home: More people failing QE
More people re-taking QE
30-person increase in 1st-timers, but…
100-person increase overall
Source: QE technical Reports webpage

9. Why bother to study effectively?
QE is foundational knowledge
Concepts support your NAVLE prep
AND help you in clinics
Use motivation of QE to learn how to learn (This isn’t the last test you’ll ever take….)
Who wants to pay another $800?

10. Example of a QE question
Which stage of the canine estrous cycle is
indicated by nonnucleated epithelial cells in
a vaginal smear?
(A) Late diestrus
(B) Late estrus
(C) Early diestrus
(D) Early proestrus
(E) Anestrus
Remember: "CORNflakes go with MILK." Think > 90% CORNified, superficial cells in canine estrus (angular, sharp edges like corn flakes, tiny pyknotic nuclei or no nuclei, no neutrophils). Full cornification usually coincides with receptivity. Follow this link to see a vaginal smear from a dog in estrus and in diestrus
B Late estrus Remember: "CORNflakes go with MILK." Think > 90% cornified, superficial cells (angular, sharp edges like corn flakes, tiny pyknotic nuclei or no nuclei) when you think canine estrus and no neutrophils. Full cornification usually coincides with receptivity. Serum progesterone can predict the LH surge and help estimate ovulation. The rule of thumb: Breed the bitch as soon as she will accept a male or as soon as you see >90% cornified, superficial, epithelial cells in a vaginal smear. Typically breed every days until the bitch enters diestrus for maximum fertility success. In contrast, diestrus vaginal smears will be dominated by nucleated, round-edged, parabasal cells and the reappearance of some neutrophils.
Sources: PAVE QE practice test The Merck Vet Manual online

11. Example of a NAVLE-style question
You are assisting a dog breeder decide when to breed
her prize Siberian mousehound.
A vaginal smear looks like this:
What would you recommend to the owner?
(A) Cannot say from this slide
(B) Cannot say with only one smear
(C) Breed the dog today
(D) We missed her estrus, wait 2 months
(E) Not in heat yet C
Source: The Zuku Review, online veterinary test prep and the Merck Manual online

12. Worth Remembering on Test Day
Show up 30 minutes early
Must have photo-i.d. to enter
Must have Authorization letter
Authorization letter arrives 5 weeks before QE, has test address
No personal belongings allowed in test room
No calculator, cell phone or digital watch
No food or drink
No backpack, brimmed hats, purse or coat
What is allowed ?
Erasable whiteboard provided for calculations
Some people bring earplugs

13. QE Topics: Not exactly “laser focused”
59%, ~ 2/3 of test
Anatomy
Physiology
Pharmacology
Microbiology
Pathology
“The QE is not designed to measure your ability to make diagnoses or manage clinical cases.” NBVME QE Candidate Bulletin,

14. QE Subtopics Got all that? Piece of cake, right?
Normal Animal, 59% of test
Anatomy, 23%
Incl. micro-anatomy, radiology, diagnostic imaging
Physiology, 23%
Incl. physiochem/biochem, neurobiology, genetics
Incl. endocrinology, reproduction, nutrition
Pharmacology, 13%
Incl. anesthesiology
Abnormal animal, 41% of test
Microbiology, 20%
Incl. bacteriology, virology, mycology, parasitology
Incl. immunology, public health, food safety, epidemiology
Pathology, 21%
Incl. clinical pathology, toxicology
Got all that? Piece of cake, right?

15. If the PAVE QE test is so broad, where do I start?
Be guided by QE sample questions
A springboard to study
A pointer to key topics
Gives you a sense of the depth, style of questions
“C”
Note: BCSE questions are similar to the QE. For more practice, try the BCSE practice test .

16. Where to start? An example
Which of the following changes occurs as
a result of metabolic acidosis?
(A) Oxygen-hemoglobin saturation curve shifts to the left
(B) Plasma becomes hypotonic
(C) Plasma ionized calcium concentration increases
(D) Serum glucose concentration increases
(E) Serum potassium concentrations decreases
“C”
Suggests “physiology & acid base” worth a review
Source: PAVE QE practice test

17. Where to start? Another example
Which of the following is the most likely finding
on a leukogram from a cow with a large
chronic abscess?
(A) Monocytosis with left shift and toxic change
(B) Neutropenia and eosinopenia
(C) Neutropenia and monocytosis
(D) Neutropenia with left shift and toxic change
(E) Neutrophilia and monocytosis E
Suggests “Clin Path / white cell function” worth a review
Source: PAVE QE practice test

18. Study SmarterTM “Successful learning is not measured by how
many hours you study.
Successful learning means using the hours
you do have effectively.” Dr. Zuku
(Steven I Mclaughlin DVM, MPH, DACVPM)

19. A study technique that doesn’t work
“I spent 6 hours reading endocrinology
on Saturday,…..
But Monday, I didn’t remember any of it !”
“Reading = Learning” 19

20. USE IT OR LOSE IT MOST adults forget 50% of what they just read
And 80% within 24 hours BUT !!
Anything you have studied well will come back very quickly with a review
….if you make good notes

21. Another study technique that doesn’t work
Treating every single factoid as if it were important Ref: Dyce, Sack and Wensing Textbook of Veterinary Anatomy
No “take home message” here! Learn to recognize the most important 3 points 21

22. Study SmarterTM Start with a calendar
Map out your study plan, week by week
Make test prep part of your routine
First Pass: finish 3 weeks before test
All study-mode tests
Write out summary notes
Second Pass: during the 3 weeks before test
All test-mode tests
Review summary notes

23. Study strategies for QE The 50:50 rule
Study ~50% -Map out the topic -Hit the books -Write summary notes -REVIEW those NOTES
Practice testing ~50% -ROUTINE a couple times a week
Goal: Finish study-mode tests, complete summary notes 3 weeks before the test

24. PAVE QE Study Plan: First Pass
Monday:
Tests: ClinAnat #1,DxImaging #1,Pharm #1,Surg#1, Physio #1 etc.  Note mistakes. ~1 hr
Study: Quick read of 5 key disease topics ~ 1 hour
Tuesday:
Tests: Do My Missed Questions from yesterday to reinforce
Start new tests- ClinAnat #2,DxImaging #2,Pharm #2,Surg#2, Physio #2 etc.
Study: Write summary notes on the 5 topics ~ 2 hours
Wednesday:
Start new tests-ClinAnat #3,DxImaging #3,Pharm #3,Surg#3, Physio #3 etc.
Study: Quick review of summary notes from Tuesday
Quick read of 5 new disease topics ~ 1 hour …………..etc
So, a typical week: Monday: Tests-- ie: ClinAnat #1, DxImaging #1, Pharm #1, Surg#1, Physio #1 etc  Note your mistakes.  ~ 1 hour (If you are within 4 weeks of the exam, do 1 Testmode test   ~ 1 hour) Study: Quick review on 5 topics from notes you've already made~ 1 hour Tuesday: Do yesterday's Missed questions in Prog review area-~ 20 min Start new tests-- Do ClinAnat #2, DxImaging #2, Pharm #2, Surg#2 etc.... ~1 hour Study: Quick review on 5 topics from notes you've already made~ 1 hour etc etc Wednesday: Do yesterday's Missed questions in Prog review area from ClinAnat #2, DxImaging #2, Pharm #2, Surg#2 etc again! ~ 20 min Start new tests-- Do ClinAnat #3, DxImaging #3, Pharm #3, Surg#3 etc.... ~1 hour (If you are within 4 weeks of the exam, do 1 Testmode test   ~ 1 hour) Study: Review summary notes you wrote on 5 topics ~ 1 hour etc etc Non-study strategies: Get regular exercise, even if it is walking the dog, hamster iguana, whatever. Get up early every day, at about the same time you will on your test day. Start out with a decent breakfast Go immediately to doing 2-3 hours of tests every day. The idea is to get your mind and body acclimated to a routine so on the big day, it feels as routine as possible too. Don't give up.  Give it your best, and on test day, walk in there with your head held high, and take it one question at a time. 24

25. Summary notes: 50% of your time
Why write summary notes?
Translates info into language your brain understands
Customized notes worth weight in gold in weeks before test
Map out the topic
DON’T reinvent the wheel
Use textbook table of contents or class syllabus
The rule of 5- never more then 5 ideas per topic
Add “Mental Velcro”
Images
Disease examples
NOTES:  The best approach (which few of us quite achieve...) is to try to finish a broad review 3 weeks before the big test. Along the way you should be summarizing your key topics with notes and giving regular time each study period to doing practice tests. You want your prep to be a routine thing you do through each week, according to a plan, not some spasmodic marathon Saturday study binge.... For the notes, they are best if organized and written by YOU. No notes I could write you or that you might find online are as good as ones where you personally processed and organized the information. It like you have written them in a language that your brain uniquely understands.

26. Mental velcro: Images
A picture IS worth a thousand words: Add pictures to your notes
Fluid-filled lungs: Pulmonary edema
“Floating lungs”: Pleural effusion
Images courtesy of Dr. Terri Defrancesco, DVM, ACVIM, All rights reserved, copyright

27. Mental velcro: Disease
Horner’s Syndrome: Remember "My 3rd Sunken Toe“ (Miosis, 3rd lid protrudes, Sunken eye, Ptosis) and "sweaty horses". A syndrome, not a disease per se.
See 4 things with Horner's, ALL associated with the eye: 1. MIOSIS (constricted pupil-lose sympathetic innervation) 2. PROTRUSION 3rd eyelid (nictitans) 3. ENOPTHALMOS (sunken eye) 4. PTOSIS (drooped eyelid), +/- anisocoria
Horner’s Syndrome: Remember "My 3rd Sunken Toe" (Miosis, 3rd lid protrudes, Sunken eye, Ptosis) and "sweaty horses". A syndrome, not a disease per se. Can see 4 things with Horner's, ALL associated with the eye: 1. MIOSIS (constricted pupil-lose sympathetic innervation) 2. PROTRUSION 3rd eyelid (nictitans) 3. ENOPTHALMOS (sunken eye) 4. PTOSIS (drooped eyelid), +/- anisocoria
What is it?
Image courtesy, Dr. Joel Mills, Wikimedia Commons 27

28. Map Out Your Topic
You are on the ground in the forest of “Pharmacology”, looking at a tree called “Misc antibiotics” and a leaf called “Rifampin”.
To figure out where you are
(and to get where you want to go),
Visualize where you are from 10,000 feet up

29. Map example: Pharmacology
Map from 10,000 feet
5 “Antis”
Antibacterials
Antifungals
Antiparasitics
Antivirals
Antineoplastics
5 “keys”
Key Cardio drugs
Key Optho drugs
Key Repro drugs
Key Endo drugs
Key Renal drugs
Misc
Key antidotes/tox reversal agents
Analgesics
Tranquilizers
Map from 1000 feet
I. Antibacterials A. ‘cidals B. ‘statics
C. Misc antibiotics
Map from 100 feet C. Misc antibiotics Chloramphenicol
2. Rifampin Metronidazole
Map on the ground Rifampin
a. Gen info
b. Primary use
c. Contraindications
d. Cautions
e. “mental velcro” (Image, disease)
You are here

30. Summary notes part 1: Pharmacology, Rifampin
2. Rifampin a.General-‘cidal or ‘static dep. on microbe
b.Primary use -Rx Rhodococcus equi, young horses
c.Contraindication -Beware in hypersens animals, hepatic dysfxn
d.Caution ). May cz red-orange urine, tears, sweat ). Don’t use alone or see rapid resistance
3). Give on empty stomach
e.Mental velcro- Rhodococcus equi
References: Plumb’s Vet Drug Formulary 5th ed. pp.992-4, Merck Vet Manual online,

31. Summary notes part 2: Rifampin Mental velcro (image and a disease)
References: Pasquini, Pasquini & Woods, Guide to Equine Clinics, 3rd ed. p. 113 Notes developed by senior veterinary student for educational use preparation for NAVLE Image courtesy, Angeline Warner, DVM, D. Sc: 31

32. Where to get a fast disease summary
From: Pasquini, Pasquini & Woods, Guide to Equine Clinics, 3rd ed. p. 113 32

33. Outside a dog, a book is a man’s best friend
Outside a dog, a book is a man’s best friend. Inside a dog, it’s too dark to read Groucho Marx
If you believe everything you read, better not read Japanese proverb 33

34. Recommended books for QE
For medicine and disease summaries:
Bovine: *Guide to Bovine Clinics 4th edition—Chris & Susan Pasquini
Equine: *Guide to Equine Clinics 3rd edition—Chris & Susan Pasquini, Phil Woods
Dogs and Cats: *Veterinary Clinical Advisor, Dogs and Cats, 1st ed. Cote' ed. *Tschauner's Guide to Small Animal Clinics 2nd ed.—Chris & Susan Pasquini Blackwell's 5 Minute Veterinary Consult, Canine-Feline 4th ed. Tilley & Smith eds.
Clinical Anatomy: Anatomy of Domestic Animals 10th edition— Pasquini, Spurgeon and Pasquini
On almost every page you find a box that tells the clinical significance, diseases associated with that part. Superb. Study those. Make short notes. Go fast.
Pharmacology: *Plumb’s Veterinary Drug Handbook, 5th edition, Donald C. Plumb
The original and a favorite, available as a book or online through VIN
Physiology: Veterinary Physiology, 4th ed. Cunningham and Klein
Good case-based organization, FAR easier to navigate than Duke’s
Clinical Pathology: Duncan and Prasse's Clinical Pathology, 4th ed.
35 excellent case studies in appendix. We like this one, but other texts are also good.
Anesthesia, dentistry, basic surgery: Clinical Textbook for Vet Techs, 7th ed, McCurnin & Bassert
Great images, good tune up on basics.
*Zuku Review Pick of the LitterTM

35. Practice testing for PAVE QE: 50% of your time
“You don't get ready for a marathon by reading a book about it. You put on your running shoes and run.” Dr. Zuku
Practice testing helps accustom your mind and body to performing in the same way that you will need to do on your test day-it gives you experience with the testing environment and an objective measure of your strong and weak points. It also helps build your expertise at coping effectively with those inevitable questions about which you don't have a ready answer.

36. Multiple choice tricks of the trade
The Good News Correct answer is GUARANTEED to be among the choices
The Bad News You WILL hit questions you don’t know Common mistake: Spending MOST of your time on questions about which you know the LEAST.
Key to success: Train yourself to MAKE CHOICES and then MOVE ON.

37. Multiple choice tricks of the trade
READ the question first (DON’T look at answers)
PREDICT the answer (protects you from distractors)
Is your answer the best of the choices ? If “Yes” SELECT it and move on
Unsure of the correct answer ? ELIMINATE wrong ones, choose from what’s left, and MOVE ON
Half the battle is training your brain and your body how to cope with answering lots of practice questions, and how to cope with the inevitable questions you don't know. Even if you studied full-time from now till test day, you can fully expect to see questions you do not know on your test.

38. “What if I don’t think this system will work for me
“What if I don’t think this system will work for me ?” Do what works for you. “How do I know when I should I change an answer ?”
Stick with your first answer unless you recognize that it is clearly not correct - studies show that changed answers are more frequently wrong.
“I am clueless about chickens/cardiology/box turtle halitosis, what do I do?”
Read, Predict, Eliminate, Select -The correct answer is guaranteed to be among the choices. Whittle the choices down to as few as possible and guess.

39. The 24-hour “golden period” of short-term memory
A mistake is the best teacher
Mistakes sting
Sting helps you remember,
…...IF you redo missed question within 24 hrs
After 24 hours, most new info fades from memory
Starting from 0
Note questions you miss today on scratch paper
Redo “Missed Questions” tomorrow
Reinforces weak areas fast

40. Sources of practice questions
QE sample test
BCSE sample test (similar to QE)
Vet Board Games cards
Zuku review QE course & Question Archive
CAPC parasitology test
Mosby’s Basic and Clin sciences questions

41. Pop Quiz What is a Cook's speculum? A) Three-pronged ear speculum
B)   Four-pronged rectal speculum
C)   Three-pronged nasal speculum       
D)   Three-pronged rectal speculum

42. Multiple choice tricks of the trade: Convergence
What is a Cook's speculum?
A)   Three-pronged ear speculum           
B)   Four-pronged rectal speculum
C)   Three-pronged nasal speculum       
D)   Three-pronged rectal speculum
This is an example of convergence.  Options A, C and D all contain the words "three-pronged“ Options B and D both contain the word "rectal." These two sets converge at option D
Adapted from: Leo M. Harvill, Ph.D. “The Test Of Obscure Medical Information”

43. Multiple choice tricks of the trade: Prognosis
Questions about prognosis tend to be all or nothing (ie: clearly GREAT or clearly HORRIBLE)
Prognosis/success rates by percentage:
Excellent % (ave: 95%) Good % (ave: 75%) Guarded/Fair % (ave: 50%)
Poor % (ave: 25%)
Grave % (ave: 5%)
Ref: Pasquini's, Tschauner's Guide to Sm. An Clinics, vol 1, 2nd ed. p. 11

44. Multiple choice tricks of the trade Images
CENTER Most photographers put lesion centrally in photos
Radiographs are an exception
Must look over WHOLE x-ray
History gives clues
Hit by car? Check for pelvic or femoral fracture, dislocation, Check for diaphragmatic hernia (bowel loop in chest)
Straining to urinate? Check bladder for stones
Regurgitation? Check for lung field for megaesophagus
No normals- Good images are hard to get UNLIKELY to see picture with nothing wrong

45. If there is a problem in this picture, where is it ? (click link)
Intussusception, Hamster, center of image Click this version for explanatory text:
Reference: The Merck Veterinary Manual online edition

46. Where is the problem? Tongue ulcer, canine leishmaniasis
Image courtesy, Dr. Peter Schantz
Canine leishmaniasis
Tongue ulcer, canine leishmaniasis 46

47. Where is the problem? What is it? Ulcer, possible descemetocoele
Image courtesy, Dr. Kim Stanz
Ulcer, poss descmetocoele
What is it?
Ulcer, possible descemetocoele 47

48. Where is the problem? What is it? Endocardiosis, mitral valve
Image courtesy, Dr. Terri Defrancesco
Mitral endocardiosis
What is it?
Endocardiosis, mitral valve 48

49. What, if anything, is wrong with this picture?
History Hint: This cat is having urinary accidents
Bladder stones
Image courtesy, Dr. Scot Nachbar
Bladder stones 49

50. If anything is wrong with this picture, in which quadrant is the problem?
History Hint: This beagle was hit by a car
Upper Left, ilial fracture
Image courtesy, Dr. Scot Nachbar
Upper left quadrant, Ilial fracture 50

51. What, if anything, is wrong with this picture?
History Hint: This 6 month old Labrador regurgitates soon after eating
Megaesophagus: note ventral deviation of the tracheal carina, and dilation of the esophagus above
Megaesophagus: note ventral deviation of tracheal carina, dilation of esophagus
Image courtesy, Dr. Terri Defrancesco 51

52. Online Case Study & Image Resources
Surgery case studies Radiology case studies Radiology artifacts Clin Path Case studies Clin Path images
Pathology/Histopathology images Vet video library: Merck images online
Tech hint:
Right-click your mouse over an internet image, to copy and paste it elsewhere

53. The final 3 weeks Second Pass
“In the final weeks before a big race, you change your training to mimic the race. In the final weeks before test day, change your study to mimic the real test” Dr. Zuku
Practice testing helps accustom your mind and body to performing in the same way that you will need to do on your test day-it gives you experience with the testing environment and an objective measure of your strong and weak points. It also helps build your expertise at coping effectively with those inevitable questions about which you don't have a ready answer.

54. The final 3 weeks Second Pass
Study
-REVIEW your notes -Skim misc topics not in notes -Test yourself with flashcards, friends, game cards
Practice testing Do timed test-mode tests -60-question tests build stamina -Random topics -No answers as you go -Mimics the real thing
Goal: Finish all test-mode tests Redo “Missed questions” within 24 hours Review summary notes until solid in your mind

55. The final 3 weeks Keep a routine
Get regular exercise …Run, swim, square-dance, walk your dog, hamster or wombat
Get up early every day, ….about same time you need to wake up on test day
Start with a decent breakfast
Go immediately into 2 hours of practice tests, then notes review
Get your mind & body into a routine so the big day feels routine too
Don't give up.
On test day, walk in with your head held high, and take it one question at a time

56. Remember 4 things ~50% study, ~50% practice testing
Redo “missed questions” w/in 24 hours
Try to finish first pass on summary notes & study-mode tests 3 weeks before test
In final 3 weeks do test-mode tests, review notes

57. If Time is Short ~1/3 time reviewing notes ~2/3 time taking tests
Read, Predict, Select, or Eliminate
Redo "My Missed Questions“ w/in 24 hours
Pay attention to images in questions
Finish all test-mode tests in final week
Stay Positive
Panic is not productive; don’t waste energy on it
Test-takers with forward momentum and a positive attitude do better on tests
Do what you can, keep moving, and don't give up

58. Good luck!
“No student knows his subject: the most he knows is where and how to find out the things he does not know.” –Woodrow Wilson

59. References
The summary of multiple choice strategies comes principally from:
“What Smart Students Know” by Adam Robinson, co-founder of The Princeton Review test preparation company George Washington University Academic Success Center- “Strategies for Multiple Choice Questions” Kaplan Test Prep US Medical Licensure Exam (USMLE) Strategy Sessions Convergence concept Adapted from: “The Test Of Obscure Medical Information” Leo M. Harvill, Ph.D.
NBVME QE Candidate Bulletin
PAVE QE score reports
PAVE QE practice tests Text version:
Web version: BCSE practice test

60. Extra slides

61. Another example of good notes
References: Cote’, Veterinary Clinical Advisor, Dogs and Cats, 1st ed, pp & Pasquini& Pasquini, Tschauner’s Guide to Small Animal Clinics, 2nd ed. p. 703 Notes developed by senior veterinary student for educational use preparation for NAVLE Image source unreferenced. May be used only for educational purposes 61

62. Another Example of Convergence
Budin's rule states that the amount of cow's milk
consumed per day for a bottle-fed baby should be
approximately               of the weight of the baby.
A)   1/10            
B)   1/8 
C)   1/7        
D)   2/10

63. Multiple choice tricks of the trade: Convergence
Budin's rule states that the amount of cow's milk consumed per day for a
bottle-fed baby should be approximately               of the weight of the baby.
A)   1/10            
B)   1/8 
C)   1/7        
D)   2/10
A, B and C are similar: they have “1” in the numerator; A and D are similar: they have “10” in the denominator.  A test-wise examinee will choose A because it appears in both sets above.  The correct answer is A.
Adapted from: Leo M. Harvill, Ph.D. “The Test Of Obscure Medical Information”