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Study Smarter
TM
Effective Study Strategies for the
North American Veterinary Licensing Exam
(NAVLE ®)
Steven I McLaughlin DVM, MPH, DACVPM
[email protected]
www.Zukureview.com
1 800 928 8218
“It is not enough to be a good chess player,
you must also play well.”
-Savielly Tartakower
A Story
Once upon a time, there was a world called veterinary medicine,
covered in many forests.
One forest was called “Dogs”; another “Pigs” and so on.
In the Dog forest, there were many trees. One tree might be called
“Cardiology” and another called “Endocrinology”.
On that Cardiology tree might be a single leaf called “Dilated
Cardiomyopathy”
One day, a good-hearted but near-sighted vet student wandered into
the Dog forest, and got so engrossed studying the bark on a single tree
that she got lost, and a big bad wolf called NAVLE came and ate her.
The End
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
Today’s talk:
North American Veterinary Licensing Exam® (NAVLE)
• NAVLE structure, pass rates
• Study strategies for NAVLE
• Test-taking strategies for NAVLE
NAVLE Structure
• 360 questions, takes all day
• Six 60-question blocks
–
–
–
–
65 minutes per block
~1 minute per question
~10% of questions have images
60 questions not counted during scoring
• Breaks
– No break once you start a block
– 45 minutes break-time available between blocks
– If finish block early, get extra break time
Reference: NBVME NAVLE FAQs page http://www.nbvme.org/?id=71
NAVLE Pass Rates
Senior Students, AVMA Accredited Veterinary Schools
Fall 2005-Spring 2009
Overall
Pass
Fall only*
Pass
Fall 05’-Spring 06’
95%
(2549/2686)
Fall 06’
88%
(2300/2616)
Fall 06’-Spring 07’
96%
(2724/2841)
Fall 07’
90%
(2486/2760)
Fall 07’-Spring 08’
97%
(2816/2903)
Fall 08’
92%
(2605/2828)
Fall 08’-Spring 09’
97%
(2908/3009)
Fall 08’
93%
(2690/2880)
Increasing pass rates 2005 through 2009
459-person increase in test-takers from accredited schools, same period
*First time test-takers, senior students, AVMA accredited veterinary schools
Reference: NBVME NAVLE results page http://www.nbvme.org/?id=82
NAVLE Pass Rates
Senior Students & Graduates of Foreign Veterinary
Schools Not Accredited by AVMA
Overall
Pass
Fall only
Pass
Fall 05’-Spring 06’
41%
(534/1312)
Fall 06’
44%
(308/698)
Fall 06’-Spring 07’
41%
(628/1546)
Fall 07’
44%
(352/799)
Fall 07’-Spring 08’
54%
(370/680)
Fall 08’
51%
(242/476)
Fall 08’-Spring 09’
64%
(481/757)
Fall 08’
68%
(271/398)
Marked Increase in pass rates 2007 through 2009
Marked decrease in test-takers from non-accredited schools, same period
Changes likely due to 2007 requirement to pass BSCE test prior to NAVLE
Reference: NBVME NAVLE results page http://www.nbvme.org/?id=82
NAVLE Pass Rates
What do they mean to me?
“No matter what the pass rates are,
you don’t pass the NAVLE by accident.
Everyone has to prepare.”
-Dr. Zuku
(Steven I Mclaughlin DVM, MPH, DACVPM)
Worth Remembering on Test Day
• Show up 30 minutes early
– Must have Scheduling Permit
– Must have unexpired government-issued identification ie:
• Driver's license or passport-includes both photo and your signature
• First, last names on i.d. must exactly match name on Sched. permit
• 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
Reference: NAVLE Candidate Bulletin: http://www.nbvme.org/?id=10&page=NAVLE+Candidate+Bulletin
NAVLE Structure
72 (24%) Canine:
72 (24%) Feline:
84% of the NAVLE
51 (17%) Bovine:
51 (17%) Equine:
12 (4%) Porcine:
9 (3%) Pet Birds:
9 (3%) Public Health and Food Security:
9 (3%) Ovine/Caprine/Cervidae:
6 (2%) Other Small Animals:
6 (2%) Poultry:
3 (1%) Non-Species Specific:
300
Reference: http://www.nbvme.org/?id=26&page=NAVLE+Test+Specifications
Remember Sutton’s Law
“Go where the money is”
Most NAVLE
points lie in
the “Big 4”
species
If the NAVLE is so broad,
where do I start?
Be guided by NAVLE sample questions
and NBVME self assessments
– A springboard to study
– A pointer to key topics
– Gives you a sense of the depth, style of questions
References: Text Sample Questions http://www.nbvme.org/?id=23&page=NAVLE+Sample+Questions
Computerized sample questions, tutorial http://www.nbvme.org/?id=80
NBVME Self-assessments http://www.nbvme.org/?id=93&page=Self-Assessments
One of the best ways to prepare for NAVLE
NBVME self assessments
• Produced by same people who write NAVLE
– $50, 200 questions, 30 days’ access
– Two versions available, both worth doing
• DON’T do all 200 questions in one sitting
• DO 10-15 questions per day
look up answers to the ones you don’t know
• Orients you to NAVLE-question style, depth
Link: Natl. Board of Veterinary Medical Examiners (NBVME) Self-assessments
http://www.nbvme.org/?id=93&page=Self-Assessments
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)
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”
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
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
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 4 weeks before test
– All study-mode tests
– Write out summary notes
• Second Pass: during the 4 weeks before test
– All test-mode tests
– Review summary notes
Study strategies for NAVLE
The 50:50 rule
Study ~50%
Practice testing ~50%
-Map out the topic
-Hit the books
-Write summary notes
-REVIEW those NOTES
-ROUTINE
a couple times a week
Goal: Finish study-mode tests, complete summary
notes 4 weeks before the test
NAVLE Study Plan
Monday:
First Pass
Tests: 1. Dog #1, Cat # 1, Cow # 1, Horse #1, Cross-species #1, ~ 1 hour
2. Do 10-15 NBVME self assessment Qs, note the ones you don't know
Study: 1. Look up answers to NBVME self assessment Qs you don't know
- no more than 20 min per question
2. Quick read of 5 key disease topics ~ 1 hour
Tuesday:
Tests: 1. Do My Missed Qs from yesterday's tests-2. Start new tests-Dog #2, Cat # 2, Cow # 2, Horse #2, Cross-sp # 2
3. Do 10-15 NBVME self assessment Qs, note the ones you don't know
Study: 1. Look up answers to NBVME self assessment Qs you don't know
2. Write 1/2 - page summary notes on the 5 topics ~ 2 hours
………………etc
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
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 2007-2010
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.
What is it?
Image courtesy,
Dr. Joel Mills, Wikimedia Commons
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
http://commons.wikimedia.org/wiki/File:Horner%
27s_syndrome_dog.JPG
Map Out Your Topic:
An easier clinical example-Cryptoccocosis
You are on the ground
in the forest of “Small Animal Medicine”,
looking at a tree called “Fungal infections”
and a leaf called “Cryptococcus”.
To figure out where you are
(and to get where you want to go),
Visualize where you are from 1000 feet up
Map example:
Important Fungal Diseases
Map from 1000 feet
Map from 100 feet
3 “C’s”
3 “C’s”
A. Candidiasis
A. Candidiasis
B. Cocciomycosis
B. Cocciomycosis
C. Cryptococcosis
C. Cryptococcosis
3 “BAH, humbugs”
A. Blastomycosis
B. Aspergillosis
C. Histoplasmosis
Map on the ground
You are here
2. Cryptococcosis
a. Presentation
b. DDX
c. Test of Choice
d. Treatment
e. Prevention/Prognosis
An example of good summary notes:
Cryptococcosis
References: Cote’, Veterinary Clinical Advisor, Dogs and Cats, 1st ed, pp. 259-60 &
Pasquini& Pasquini, Tschauner’s Guide to Small Animal Clinics, 2nd ed. p. 703
Notes developed by senior veterinary student for educational use in preparation for NAVLE
Image source unreferenced. May be used only for educational purposes
Map Out Your Topic:
A harder example-Pharmacology
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
Map example: Pharmacology
Map from 10,000 feet
Map from 1000 feet
5 “Antis”
Antibacterials
Antifungals
Antiparasitics
Antivirals
Antineoplastics
I. Antibacterials
A. ‘cidals
B. ‘statics
C. Misc antibiotics
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 100 feet
C. Misc antibiotics
1. Chloramphenicol
2. Rifampin
3. Metronidazole
Map on the ground
You are here
2. Rifampin
a. Gen info
b. Primary use
c. Contraindications
d. Cautions
e. “mental velcro” (Image, disease)
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 5th ed. pp.992-4,
Merck Vet Manual online, http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/191282.htm
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: http://ocw.tufts.edu/Content/27/imagegallery/367446/367480
Where to get a fast disease summary
From: Pasquini, Pasquini & Woods, Guide to Equine Clinics, 3rd ed. p. 113
Where to start with summary notes
• Summarize most important diseases first ie:
– Heartworm more important than aortic coarctation (whatever that is)
– Diabetes mellitus more important than pheochromocytoma
– Equine laminitis more important than rare rachitic ringbone
• Not sure where to start?
• See suggested “Top 20s” on the Zuku Review website
• Feeling ambitious?
The 2003 NAVLE Job Analysis survey lists about a 1000
conditions you can bone up on…….
http://nbvme.org/?id=13&page=NAVLE+Job+Analysis+2003
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
Recommended books for NAVLE
For medicine and disease summaries:
Bovine: *Guide to Bovine Clinics 4th ed.—Pasquini
Equine: *Guide to Equine Clinics 3rd ed.—Pasquini & Woods
Dogs and Cats:
*Veterinary Clinical Advisor, Dogs and Cats, 1st ed. Cote' ed.
*Tschauner's Guide to Small Animal Clinics 2nd ed.—Pasquini
Blackwell's 5 Minute Vet Consult, Canine-Feline 4th ed. Tilley & Smith eds.
Pharmacology: *Plumb’s Veterinary Drug Handbook, 5th edition, Donald C.
Plumb
– The original and a favorite, available as a book or online through VIN
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.
*Zuku Review Pick of the Litter
TM
Practice testing for NAVLE:
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
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.
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
“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.
The 24-hour “golden period” of shortterm 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
• Note questions you miss today on scratch paper
• Redo “Missed Questions” tomorrow
– Reinforces weak areas fast
Sources of practice questions
Free
•
NAVLE sample tests
Text version http://www.nbvme.org/?id=23&page=NAVLE+Sample+Questions
Computerized version http://www.nbvme.org/?id=80
•
•
•
CAPC parasitology test http://www.capcvet.org/other/resources.html
Vet Board Games question of the day http://www.veterinaryboardgames.com/qod.html
Zuku Review Question of the day Archive http://zukureview.com/QOD_Archive.PHP
Subscription-based
•
•
•
•
NBVME Self Assessments http://www.nbvme.org/?id=93&page=Self-Assessments
VIN NAVLE prep course http://www.vin.com/ce/MULT205-0909.htm
Vetprep online NAVLE course http://www.vetprep.com/sb/web/
Zuku Review online NAVLE course http://zukureview.com/index.php
Other NAVLE prep aids
•
•
Vet Board Games cards & iPhone application http://www.veterinaryboardgames.com/
Saunders Comprehensive Review for the NAVLE®, Patricia Schenck DVM, PhD
(Paperback with CD-due out late Sept. 2009-no information available yet on contents)
Pop Quiz
What is a Cook's speculum?
A)
B)
C)
D)
Three-pronged ear speculum
Four-pronged rectal speculum
Three-pronged nasal speculum
Three-pronged rectal speculum
Multiple choice tricks of the trade:
Convergence
What is a Cook's speculum?
A)
B)
C)
D)
Three-pronged ear speculum
Four-pronged rectal speculum
Three-pronged nasal speculum
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”
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
Good
Guarded/Fair
Poor
Grave
90-100%
65-89%
35-64%
11-34%
1-10%
(ave: 95%)
(ave: 75%)
(ave: 50%)
(ave: 25%)
(ave: 5%)
Ref: Pasquini's, Tschauner's Guide to Sm. An Clinics, vol 1, 2nd ed. p. 11
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
If there is a problem in this picture,
where is it ?
(click link)
http://www.merckvetmanual.com/mvm/htm/bc/z-exlha29.htm
Intussusception, Hamster, center of image
Click this version for explanatory text:
http://www.merckvetmanual.com/mvm/htm/bc/z-exlha29.htm
Reference: The Merck Veterinary Manual online edition
http://www.merckvetmanual.com/mvm/index.jsp
Where is the problem?
Image courtesy,
Dr. Peter Schantz
Tongue ulcer, canine leishmaniasis
Where is the problem?
Image courtesy,
Dr. Kim Stanz
What is it?
Ulcer, possible descemetocoele
Where is the problem?
Image courtesy,
Dr. Terri
Defrancesco
What is it?
Endocardiosis, mitral valve
What, if anything, is wrong with this picture?
History
Hint:
This cat is
having
urinary
accidents
Bladder stones
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
Image courtesy,
Dr. Scot Nachbar
What, if anything, is wrong with this picture?
History
Hint:
This 6 month
old Labrador
regurgitates
soon after
eating
Megaesophagus: note ventral deviation
of tracheal carina, dilation of esophagus
Image courtesy,
Dr. Terri Defrancesco
Online Case Study & Image Resources
Surgery case studies
http://www.acvs.org/AnimalOwners/HealthConditions/
Radiology case studies
http://www.vet.k-state.edu/depts/VMTH/radiology/cow/index.htm
Radiology artifacts
http://vet.osu.edu/index.php?id=2355
Tech hint:
Clin Path Case studies
http://www.medvet.umontreal.ca/clinpath/choice.htm
Clin Path images
http://www.medvet.umontreal.ca/clinpath/banq-im/menuE.htm
Pathology/Histopathology images http://w3.vet.cornell.edu/nst/nst.asp
Right-click
your mouse
over an
internet image,
to copy and
paste it
elsewhere
Vet video library: www.vetvideos.com
Merck images online
http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/mvm_list_img.htm
The final 4 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
The final 4 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
The final 4 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
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 4 weeks before test
4.
In final 4 weeks do test-mode tests, review notes
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
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
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.
NAVLE Candidate Bulletin
http://www.nbvme.org/?id=10&page=NAVLE+Candidate+Bulletin
Text Sample Questions http://www.nbvme.org/?id=23&page=NAVLE+Sample+Questions
Computerized sample questions, tutorial http://www.nbvme.org/?id=80
NBVME Self-assessments http://www.nbvme.org/?id=93&page=Self-Assessments