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Steven I McLaughlin DVM, MPH, DACVPM 1 800 928 8218 Study Smarter TM Effective.

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Presentation on theme: "Steven I McLaughlin DVM, MPH, DACVPM 1 800 928 8218 Study Smarter TM Effective."— Presentation transcript:

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

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 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 ? 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 (A) 58% (B) 69% (C) 70% (D) 78% (E) 89%

8 QE Pass Rates and Trends Took QE Sep 05’, Jan, May 06’ 299 (all) 270 (1 st attempt) Sep 07’, Jan, May 08’ 398(all) 303 (1 st attempt) 30-person increase in 1 st -timers, but… Pass (%) 230 (77%) 216 (80%) 252 (63%) 212 (70%) Take home: More people failing QE More people re-taking QE 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 Sources: PAVE QE practice test The Merck Vet Manual online 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

11 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 Source: The Zuku Review, online veterinary test prep and the Merck Manual online Example of a NAVLE-style question

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” 1)Anatomy 2)Physiology 3)Pharmacology 4)Microbiology 5)Pathology 59%, ~ 2/3 of test “The QE is not designed to measure your ability to make diagnoses or manage clinical cases.” NBVME QE Candidate Bulletin,

14 QE Subtopics 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 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 Source: PAVE QE practice test Suggests “physiology & acid base” worth a review

17 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 Source: PAVE QE practice test Suggests “Clin Path / white cell function” worth a review Where to start? Another example

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

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

22 Study Smarter TM 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 Goal: Finish study-mode tests, complete summary notes 3 weeks before the test Study ~50% -Map out the topic -Hit the books -Write summary notes -REVIEW those NOTES Practice testing ~50% -ROUTINE a couple times a week

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: Tests: Do My Missed Questions from yesterday to reinforce 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

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

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 Image courtesy, Dr. Joel Mills, Wikimedia Commons Mental velcro: Disease What is it? 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 27s_syndrome_dog.JPG

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 1. Chloramphenicol 2. Rifampin 3. Metronidazole Map on the ground 2. 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 1). May cz red-orange urine, tears, sweat 2). Don’t use alone or see rapid resistance 3). Give on empty stomach e.Mental velcro- Rhodococcus equi References: Plumb’s Vet Drug Formulary 5 th 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, 3 rd ed. p. 113 Notes developed by senior veterinary student for educational use preparation for NAVLE Image courtesy, Angeline Warner, DVM, D. Sc:

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

33 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

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 Litter TM

35 “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 for PAVE QE: 50% of your time

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

38 “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 golden period 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 Note questions you miss today on scratch paper Redo “Missed Questions” tomorrow –Reinforces weak areas fast fades from memoryAfter 24 hours, most new info fades from memory

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 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 Pop Quiz

42 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 Multiple choice tricks of the trade: Convergence Adapted from: Leo M. Harvill, Ph.D. “The Test Of Obscure Medical Information”

43 Questions about prognosis tend to be all or nothing (ie: clearly GREAT or clearly HORRIBLE) Prognosis/success rates by percentage: Excellent % (ave: 95%) Good 65-89% (ave: 75%) Guarded/Fair 35-64% (ave: 50%) Poor 11-34% (ave: 25%) Grave 1-10% (ave: 5%) Multiple choice tricks of the trade: Prognosis Ref: Pasquini's, Tschauner's Guide to Sm. An Clinics, vol 1, 2nd ed. p. 11

44 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 Multiple choice tricks of the trade Images

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

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

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

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

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

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

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 “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 The final 3 weeks Second Pass

54 Goal: Finish all test-mode tests Redo “Missed questions” within 24 hours Review summary notes until solid in your mind 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

55 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 The final 3 weeks Keep a routine

56 Remember 4 things 1.~50% study, ~50% practice testing 2.Redo “missed questions” w/in 24 hours 3.Try to finish first pass on summary notes & study-mode tests 3 weeks before test 4.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 “No student knows his subject: the most he knows is where and how to find out the things he does not know.” –Woodrow Wilson Good luck!

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.The Princeton ReviewStrategies for Multiple Choice Questions Kaplan Test Prep NBVME QE Candidate Bulletin PAVE QE score reports PAVE QE practice tests Text version: Web version: BCSE practice test

60 Extra slides

61 References: Cote’, Veterinary Clinical Advisor, Dogs and Cats, 1st ed, pp & Pasquini& Pasquini, Tschauner’s Guide to Small Animal Clinics, 2 nd 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 Another example of good notes

62 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 Another Example of Convergence

63 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. 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 Multiple choice tricks of the trade: Convergence Adapted from: Leo M. Harvill, Ph.D. “The Test Of Obscure Medical Information”

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