Presentation on theme: "Study SmarterTM Effective Study Strategies for the PAVE Qualifying Exam (QE) Steven I McLaughlin DVM, MPH, DACVPM Steve@Zukureview.com www.Zukureview.com."— Presentation transcript:
1Study 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
3A StoryOnce upon a time, there was a world called veterinary medicine,covered in many forests.One forest was called “Pharmacology”; another “Physiology” andso on.In the Pharmacology forest, there were many trees. One treewas called “Antibiotics” and another called “Antiparasitics”.On that antibiotics tree was a single leaf called “Rifampin”One day, a good-hearted but near-sightedvet student wandered into the pharmacologyforest, and got so engrossed studying a leafon a single tree that she got lost, and a bigbad wolf called PAVE QE came and ate her The End
4The need for speed It is time to go fast, people. The goal is not to know everythingThe goal is not to get every question rightThe goal is to passIn the forests of knowledge, let this be your map
5QE 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 ratesStudy strategies for QETest-taking strategies for QE
6QE Structure 300 questions, takes all day Two 150-question blocks 165 minutes per block (almost 3 hours!)~1 minute per question10% of questions have imagesTypically, questions not counted during scoringBreaksNo break once you start a block45 minute break between blocksIf finish block early, get extra break time
7Pop QuizWhat 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
8QE Pass Rates and Trends Took QESep 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 QEMore people re-taking QE30-person increase in 1st-timers, but…100-person increase overallSource: QE technical Reports webpage
9Why bother to study effectively? QE is foundational knowledgeConcepts support your NAVLE prepAND help you in clinicsUse motivation of QE to learn how to learn (This isn’t the last test you’ll ever take….)Who wants to pay another $800?
10Example of a QE question Which stage of the canine estrous cycle isindicated by nonnucleated epithelial cells ina vaginal smear?(A) Late diestrus(B) Late estrus(C) Early diestrus(D) Early proestrus(E) AnestrusRemember: "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 diestrusB 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
11Example of a NAVLE-style question You are assisting a dog breeder decide when to breedher 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 yetCSource: The Zuku Review, online veterinary test prep and the Merck Manual online
12Worth Remembering on Test Day Show up 30 minutes earlyMust have photo-i.d. to enterMust have Authorization letterAuthorization letter arrives 5 weeks before QE, has test addressNo personal belongings allowed in test roomNo calculator, cell phone or digital watchNo food or drinkNo backpack, brimmed hats, purse or coatWhat is allowed ?Erasable whiteboard provided for calculationsSome people bring earplugs
13QE Topics: Not exactly “laser focused” 59%, ~ 2/3 of testAnatomyPhysiologyPharmacologyMicrobiologyPathology“The QE is not designed to measure your ability to make diagnoses or manage clinical cases.” NBVME QE Candidate Bulletin,
14QE Subtopics Got all that? Piece of cake, right? Normal Animal, 59% of testAnatomy, 23%Incl. micro-anatomy, radiology, diagnostic imagingPhysiology, 23%Incl. physiochem/biochem, neurobiology, geneticsIncl. endocrinology, reproduction, nutritionPharmacology, 13%Incl. anesthesiologyAbnormal animal, 41% of testMicrobiology, 20%Incl. bacteriology, virology, mycology, parasitologyIncl. immunology, public health, food safety, epidemiologyPathology, 21%Incl. clinical pathology, toxicologyGot all that? Piece of cake, right?
15If the PAVE QE test is so broad, where do I start? Be guided by QE sample questionsA springboard to studyA pointer to key topicsGives 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 .
16Where to start? An example Which of the following changes occurs asa 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 reviewSource: PAVE QE practice test
17Where to start? Another example Which of the following is the most likely findingon a leukogram from a cow with a largechronic 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 monocytosisESuggests “Clin Path / white cell function” worth a reviewSource: PAVE QE practice test
18Study SmarterTM “Successful learning is not measured by how many hours you study.Successful learning means using the hoursyou do have effectively.” Dr. Zuku(Steven I Mclaughlin DVM, MPH, DACVPM)
19A study technique that doesn’t work “I spent 6 hours reading endocrinologyon Saturday,…..But Monday, I didn’t remember any of it !”“Reading = Learning”19
20USE 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
21Another study technique that doesn’t work Treating every single factoid as if it were important Ref: Dyce, Sack and Wensing Textbook of Veterinary AnatomyNo “take home message” here! Learn to recognize the most important 3 points21
22Study SmarterTM Start with a calendar Map out your study plan, week by weekMake test prep part of your routineFirst Pass: finish 3 weeks before testAll study-mode testsWrite out summary notesSecond Pass: during the 3 weeks before testAll test-mode testsReview summary notes
23Study strategies for QE The 50:50 rule Study ~50% -Map out the topic -Hit the books -Write summary notes -REVIEW those NOTESPractice testing ~50% -ROUTINE a couple times a weekGoal: Finish study-mode tests, complete summary notes 3 weeks before the test
24PAVE QE Study Plan: First Pass Monday:Tests: ClinAnat #1,DxImaging #1,Pharm #1,Surg#1, Physio #1 etc. Note mistakes. ~1 hrStudy: Quick read of 5 key disease topics ~ 1 hourTuesday:Tests: Do My Missed Questions from yesterday to reinforceStart new tests- ClinAnat #2,DxImaging #2,Pharm #2,Surg#2, Physio #2 etc.Study: Write summary notes on the 5 topics ~ 2 hoursWednesday:Start new tests-ClinAnat #3,DxImaging #3,Pharm #3,Surg#3, Physio #3 etc.Study: Quick review of summary notes from TuesdayQuick read of 5 new disease topics ~ 1 hour …………..etcSo, 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
25Summary notes: 50% of your time Why write summary notes?Translates info into language your brain understandsCustomized notes worth weight in gold in weeks before testMap out the topicDON’T reinvent the wheelUse textbook table of contents or class syllabusThe rule of 5- never more then 5 ideas per topicAdd “Mental Velcro”ImagesDisease examplesNOTES: 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.
26Mental velcro: ImagesA picture IS worth a thousand words: Add pictures to your notesFluid-filled lungs: Pulmonary edema“Floating lungs”: Pleural effusionImages courtesy of Dr. Terri Defrancesco, DVM, ACVIM, All rights reserved, copyright
27Mental 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), +/- anisocoriaHorner’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), +/- anisocoriaWhat is it?Image courtesy, Dr. Joel Mills, Wikimedia Commons27
28Map Out Your TopicYou 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
29Map example: Pharmacology Map from 10,000 feet5 “Antis”AntibacterialsAntifungalsAntiparasiticsAntiviralsAntineoplastics5 “keys”Key Cardio drugsKey Optho drugsKey Repro drugsKey Endo drugsKey Renal drugsMiscKey antidotes/tox reversal agentsAnalgesicsTranquilizersMap from 1000 feetI. Antibacterials A. ‘cidals B. ‘staticsC. Misc antibioticsMap from 100 feet C. Misc antibiotics Chloramphenicol2. Rifampin MetronidazoleMap on the ground Rifampina. Gen infob. Primary usec. Contraindicationsd. Cautionse. “mental velcro” (Image, disease)You are here
30Summary notes part 1: Pharmacology, Rifampin 2. Rifampin a.General-‘cidal or ‘static dep. on microbeb.Primary use -Rx Rhodococcus equi, young horsesc.Contraindication -Beware in hypersens animals, hepatic dysfxnd.Caution ). May cz red-orange urine, tears, sweat ). Don’t use alone or see rapid resistance3). Give on empty stomache.Mental velcro- Rhodococcus equiReferences: Plumb’s Vet Drug Formulary 5th ed. pp.992-4, Merck Vet Manual online,
31Summary 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
32Where to get a fast disease summary From: Pasquini, Pasquini & Woods, Guide to Equine Clinics, 3rd ed. p. 11332
33Outside 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 MarxIf you believe everything you read, better not read Japanese proverb33
34Recommended books for QE For medicine and disease summaries:Bovine: *Guide to Bovine Clinics 4th edition—Chris & Susan PasquiniEquine: *Guide to Equine Clinics 3rd edition—Chris & Susan Pasquini, Phil WoodsDogs 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 PasquiniOn 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. PlumbThe original and a favorite, available as a book or online through VINPhysiology: Veterinary Physiology, 4th ed. Cunningham and KleinGood case-based organization, FAR easier to navigate than Duke’sClinical 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 & BassertGreat images, good tune up on basics.*Zuku Review Pick of the LitterTM
35Practice 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. ZukuPractice 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.
36Multiple choice tricks of the trade The Good News Correct answer is GUARANTEED to be among the choicesThe 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.
37Multiple 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 onUnsure of the correct answer ? ELIMINATE wrong ones, choose from what’s left, and MOVE ONHalf 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.
39The 24-hour “golden period” of short-term memory A mistake is the best teacherMistakes stingSting helps you remember,…...IF you redo missed question within 24 hrsAfter 24 hours, most new info fades from memoryStarting from 0Note questions you miss today on scratch paperRedo “Missed Questions” tomorrowReinforces weak areas fast
40Sources of practice questions QE sample testBCSE sample test (similar to QE)Vet Board Games cardsZuku review QE course & Question ArchiveCAPC parasitology testMosby’s Basic and Clin sciences questions
41Pop Quiz What is a Cook's speculum? A) Three-pronged ear speculum B) Four-pronged rectal speculumC) Three-pronged nasal speculum D) Three-pronged rectal speculum
42Multiple choice tricks of the trade: Convergence What is a Cook's speculum?A) Three-pronged ear speculum B) Four-pronged rectal speculumC) Three-pronged nasal speculum D) Three-pronged rectal speculumThis 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 DAdapted from: Leo M. Harvill, Ph.D. “The Test Of Obscure Medical Information”
43Multiple 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
44Multiple choice tricks of the trade Images CENTER Most photographers put lesion centrally in photosRadiographs are an exceptionMust look over WHOLE x-rayHistory gives cluesHit by car? Check for pelvic or femoral fracture, dislocation, Check for diaphragmatic hernia (bowel loop in chest)Straining to urinate? Check bladder for stonesRegurgitation? Check for lung field for megaesophagusNo normals- Good images are hard to get UNLIKELY to see picture with nothing wrong
45If 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
46Where is the problem? Tongue ulcer, canine leishmaniasis Image courtesy, Dr. Peter SchantzCanine leishmaniasisTongue ulcer, canine leishmaniasis46
47Where is the problem? What is it? Ulcer, possible descemetocoele Image courtesy, Dr. Kim StanzUlcer, poss descmetocoeleWhat is it?Ulcer, possible descemetocoele47
48Where is the problem? What is it? Endocardiosis, mitral valve Image courtesy, Dr. Terri DefrancescoMitral endocardiosisWhat is it?Endocardiosis, mitral valve48
49What, if anything, is wrong with this picture? History Hint: This cat is having urinary accidentsBladder stonesImage courtesy, Dr. Scot NachbarBladder stones49
50If anything is wrong with this picture, in which quadrant is the problem? History Hint: This beagle was hit by a carUpper Left, ilial fractureImage courtesy, Dr. Scot NachbarUpper left quadrant, Ilial fracture50
51What, if anything, is wrong with this picture? History Hint: This 6 month old Labrador regurgitates soon after eatingMegaesophagus: note ventral deviation of the tracheal carina, and dilation of the esophagus aboveMegaesophagus: note ventral deviation of tracheal carina, dilation of esophagusImage courtesy, Dr. Terri Defrancesco51
52Online Case Study & Image Resources Surgery case studies Radiology case studies Radiology artifacts Clin Path Case studies Clin Path imagesPathology/Histopathology images Vet video library: Merck images onlineTech hint:Right-click your mouse over an internet image, to copy and paste it elsewhere
53The 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. ZukuPractice 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.
54The final 3 weeks Second Pass Study-REVIEW your notes -Skim misc topics not in notes -Test yourself with flashcards, friends, game cardsPractice testing Do timed test-mode tests -60-question tests build stamina -Random topics -No answers as you go -Mimics the real thingGoal: Finish all test-mode tests Redo “Missed questions” within 24 hours Review summary notes until solid in your mind
55The final 3 weeks Keep a routine Get regular exercise …Run, swim, square-dance, walk your dog, hamster or wombatGet up early every day, ….about same time you need to wake up on test dayStart with a decent breakfastGo immediately into 2 hours of practice tests, then notes reviewGet your mind & body into a routine so the big day feels routine tooDon't give up.On test day, walk in with your head held high, and take it one question at a time
56Remember 4 things ~50% study, ~50% practice testing Redo “missed questions” w/in 24 hoursTry to finish first pass on summary notes & study-mode tests 3 weeks before testIn final 3 weeks do test-mode tests, review notes
57If Time is Short ~1/3 time reviewing notes ~2/3 time taking tests Read, Predict, Select, or EliminateRedo "My Missed Questions“ w/in 24 hoursPay attention to images in questionsFinish all test-mode tests in final weekStay PositivePanic is not productive; don’t waste energy on itTest-takers with forward momentum and a positive attitude do better on testsDo what you can, keep moving, and don't give up
58Good 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
59ReferencesThe 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 BulletinPAVE QE score reportsPAVE QE practice tests Text version:Web version: BCSE practice test
61Another 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 purposes61
62Another Example of Convergence Budin's rule states that the amount of cow's milkconsumed per day for a bottle-fed baby should beapproximately of the weight of the baby.A) 1/10 B) 1/8 C) 1/7 D) 2/10
63Multiple choice tricks of the trade: Convergence Budin's rule states that the amount of cow's milk consumed per day for abottle-fed baby should be approximately of the weight of the baby.A) 1/10 B) 1/8 C) 1/7 D) 2/10A, 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”