Improving Test Performance Test-Taking Tips

1. Improving Test PerformanceTest-Taking Tips Victor Almeida, DO, FACEP, FACOEP Chairman of Emergency Medicine Monmouth Medical Center

2. Disclosures • No conflicts to disclose

3. Introductory Comments Purpose of this presentation Objectives Maximize performance on your exam Maximize effectiveness as you prepare Improve efficiency as you study Outcomes Creation of an individualized strategy

4. Examinee Comments • “Some of those questions were very tricky” Superficial versus Deep Learning • “No one told me that I’d be tested on that” Examination Blueprints • “Test scores don’t correlate with patient care” Not according to recent literature • “If I would have had more time to study…..” Time allocation and utilization • “I’m not a good standardized test-taker” “I’m not a good standardized test-preparer” Effective > Efficient; Deliberate Practice

5. Examination Performance Positive Deviance _ X

6. How do you plan to study? • 40 hours for 1 week OR 10 hours / week x 4 weeks? • Read review books OR review your own notes? • Use a Q&A resource OR study with a colleague? • Underline while reading OR highlight reading?

7. How do you plan to take the test? • What guessing strategies will you use? • What’s the impact of test anxiety (for you)?

8. Lower Level Item What is the recommended (AAP) dose of amoxicillin for acute otitis media? • 20 – 40 mg/kg/day • 30 – 50 mg/kg/day • 40 – 60 mg/kg/day • 80 – 90 mg/kg/day • 100 – 120 mg/kg/day

9. Higher Level Item • Certain versus Uncertain AOM • Acute Onset • Middle Ear Effusion • Middle Ear Inflammation • Severe vs Non-severe AOM • Moderate-to-Severe Otalgia • Temp > 39°C 3. Age (< 6mo; 6mo – 24mo; > 24mo) A 6yo child with a stuffy nose and fever (T max = 101.6°F orally) complains of intermittent mild ear pain for three days. Physical examination reveals a dull left tympanic membrane with a distorted cone of light; there is no associated effusion. The right TM is normal in appearance. The child weighs 52 pounds. What is the recommended treatment for this patient? • amoxicillin 250 mg po q 8 hrs for 10 days • amoxicillin 250 mg po q 8 hrs for 5 days • ceftriaxone 500 mg IM • ceftriaxone 1 Gm IM • acetaminophen prn and follow-up in 24 – 48 hours • Convert pounds to kg • Know daily dose amoxicillin (mg/kg) • Multiple kg times daily dose

10. Stem (vignette) Length Short scenario (98 % 82%) Long scenario (98% 66%) Take Home Message #1 Reading Accuracy & Fluency

11. Why are Standardized Tests so hard? Faculty-generated tests Standardized tests Take Home Message #2 How you prepare matters

12. SOAR R E S O U R C E S Retrieval Storage Organize L T M S T M Selection Attention EncodingAssociate Jairam & Kiewra (2009)

13. What about MOST Review Courses? Students that attended commercial review courses for the USMLE Step 1 (for up to 4 weeks) did not achieve higher scores than students that studied on their own. Werner & Bull 2003

14. What about EM Review Courses? Review Course / In-Training Examinations 5-hour sessions over 8 week period No change in ITE scores Cheng D. Int J EM 2008

15. MOST Review Courses Lack Impact Because…. Limit the individual’s opportunity to: Focus on self-determined weaknesses Integrate what needs to be known Develop skills likely to be helpful before and during the testing situation

16. BEST Review Courses…… Improve examinee performance because they include a discussion of the importance of test-taking and test-wiseness skills. Take Home Message #3 TT & TW Skills explain significant differences in examination performance

17. Test-Wiseness & Test-Taking Test Score PreparationPerformance (Before the exam) (During the exam)

18. Self-Directed Learning Methods Develop a Strategy Choose strategy to meet your needs Reading 50% of time should be spent reflecting Strengthen Comprehension Paraphrasing (increase understanding) Outline major points McWhorter 1998

19. Total-Time Hypothesis Reading next day (Distributive Trials) Reduces time required to “relearn it” Increase memory Self-Directed Learning Methods Ebbinghaus 1880; Medina 2008

20. Self-Evaluation Be sure “Closing the Gap” Question-and-Answer Sessions (Books) Maximize potential Self-Directed Learning Methods Take Home Message #4 Deliberate Practice builds Skills

21. Question-and-Answer Books Answer one question per minute Make notations when answering I know this I think I know this This is a guess Self-Directed Learning Methods

22. Question-and-Answer Books BEFORE you score your answers Read the explanations Self-Directed Learning Methods

23. Question-and-Answer Books When checking work This is a guess Got these right – work to do! I know this Got these wrong – LOTS of work to do! Self-Directed Learning Methods

24. Escape Syndrome Sitting around thinking about/talking about “how bad it’s going to be”… Self-Directed Learning Methods Take Home Message #5 Time Management is critical

25. Test-Wiseness & Test-Taking Test Score Preparation Performance (Before the exam)(During the exam)

26. When GUESSING is the ONLY alternative What improves scores? During the Examination

27. A patient with a history of angina and syncope is noted to have a systolic murmur. Which one of the following sets of findings distinguishes chronic mitral regurgitation from other etiologies? Laterally displaced PMI, normal S2, murmur intensity decreases with Valsalva Normal PMI, split S2, murmur is loudest during midsystole Laterally displaced PMI, normal S2, murmur is loudest during late systole Sustained PMI (heave), normal S2, murmur radiates to apex Laterally displaced PMI, split S2, murmur intensity decreases with Valsalva Deductive Approach

28. When GUESSING is the ONLY alternative Deductive Approach (Convergence) W & X Y & Z X & Y V & Z X & Z During the Examination Smith 1982

29. When GUESSING is the ONLY alternative Deductive Approach (Convergence) W & X Y & Z X & Y V & Z X & Z During the Examination Smith 1982

30. A patient with a history of angina and syncope is noted to have a systolic murmur. Which one of the following sets of findings distinguishes chronic mitral regurgitation from other etiologies? Laterally displaced PMI, normal S2, murmur intensity decreases with Valsalva Normal PMI, split S2, murmur is loudest during midsystole Laterally displaced PMI, normal S2, murmur is loudest during late systole Sustained PMI (heave), normal S2, murmur radiates to apex Laterally displaced PMI, split S2, murmur intensity decreases with Valsalva Deductive Approach

31. A patient with a history of angina and syncope is noted to have a systolic murmur. Which one of the following sets of findings distinguishes chronic mitral regurgitation from other etiologies? Laterally displaced PMI, normal S2, murmur intensity decreases with Valsalva Normal PMI, split S2, murmur is loudest during midsystole Laterally displaced PMI, normal S2, murmur is loudest during late systole Sustained PMI (heave), normal S2, murmur radiates to apex Laterally displaced PMI, split S2, murmur intensity decreases with Valsalva Deductive Approach

32. According to Guidelines published by the American College of Cardiologists, which one of the following is an indication for a permanent pacemaker in patients with an acute myocardial infarction? Right bundle-branch block with a prolonged PR interval Right and left bundle-branch blocks New left bundle-branch block Persistent and symptomatic second degree AV block Accelerated idioventricular rhythm Clang Association

33. When GUESSING is the ONLY alternative Clang Association Similarity between a word in the stem and correct response. During the Examination Diamond & Evans 1972

34. According to Guidelines published by the American College of Cardiologists, which one of the following is an indication for a permanentpacemaker in patients with an acute myocardial infarction? Right bundle-branch block with a prolonged PR interval Right and left bundle-branch blocks New left bundle-branch block Persistent and symptomatic second degree AV block Accelerated idioventricular rhythm Clang Association

35. Longest Alternative Along the eastern coast of Maine, the cases of huestoolduds are most often secondary to: poor nutrition. the moisture in the frocklesters. the abundance of greezles. a relative abundance of kleasternezers. an oversupply of fhoulsteens that occur directly as a result of kjuoost, djurts and bhespernets maldoorneys.

36. When GUESSING is the ONLY alternative Longest Alternative Often the exam writer wants to be sure you have enough information to recognize the correct response. During the Examination Chase 1964

37. Longest Alternative Along the eastern coast of Maine, the cases of huestoolduds are most often secondary to: poor nutrition. the moisture in the frocklesters. the abundance of greezles. a relative abundance of kleasternezers. an oversupply of fhoulsteens that occur directly as a result of kjuoost, djurts and bhespernets maldoorneys.

38. Grammar Agreement What probable etiologies are suggested when drugges foss in extremis? Sloorgs thanceed with the droxemia Potcoms fotted secondary to an oral deficiency The dagts ptopted and the frodds roanzed The dhiths buazzed secondary to gastrointestinal crooleets Taggoks were removed from the juklets

39. When GUESSING is the ONLY alternative Grammar Agreement The stem and responses should be grammatically correct… Singular stem should not be completed by plural option During the Examination Broad & Whitney 1972

40. Grammar Agreement What probable etiologies are suggested when drugges foss in extremis? Sloorgs thanceed with the droxemia Potcoms fotted secondary to an oral deficiency The dagts ptopted and the frodds roanzed The dhiths buazzed secondary to gastrointestinal crooleets Taggoks were removed from the juklets

41. Specific Determiners Patients suffering from strugleum frequently undertrosl the gruifreit because: all patients with strugleum have krodncurz. strugleum always presents with qugruestful. there are never cases of strugleum without feskabolose. patients with strugleum commonly have gizzlehorst. no fuegrools results in strugleum.

42. When GUESSING is the ONLY alternative Specific Determiners The implication of absoluteness (always, never, must, none, only…) is often incorrect. Words that permit exception (seldom, usually, often, perhaps, etc) are more commonly associated with the correct response. During the Examination Milman 1965

43. Specific Determiners Patients suffering from strugleum frequently undertrosl the gruifreit because: all patients with strugleum have krodncurz. strugleum always presents with qugruestful. there are never cases of strugleum without feskabolose. patients with strugleum commonly have gizzlehorst. no fuegrools results in strugleum.

44. Specific Determiners Patients suffering from strugleum frequently undertrosl the gruifreit because: all patients with strugleum have krodncurz. strugleum always presents with qugruestful. there are never cases of strugleum without feskabolose. patients with strugleum commonly have gizzlehorst. no fuegrools results in strugleum.

45. Can Cause Psychological Changes GI Symptoms, Insomnia, Headaches Emotional Changes Irritability, Moodiness, Frustration, Anger Cognitive Changes Memory Blocks, Attention Span Limitations Test Anxiety

46. Ways to Reduce Understand the Examination Test Blueprint (Table of Specifications) Build Confidence Study effectively & efficiently Plan Studying & Improve Study Skills Pilot Items Don’t count in your Final Score Test Anxiety

47. Testing Experience(Certification) Work Station (CBT) Brightness and contrast controls Striking of content feature White boards and scrap paper from proctor Exam Length 4 hour morning 40 minute optional break 2 hour afternoon AOBEM (www.aobem.org)

48. Item Formats(Certification & Recertification) Stand Alone Stem and Distracters Item Set Common stem and multiple questions AOBEM (www.aobem.org)

49. Test Blueprint (Table of Specificity) Core Content Categories 20 33 page document Ranked High (H), Medium (M) Low (L) AOBEM (www.aobem.org)

50. My experience Study Plan Six Weeks (@ 10 hours per week) Parting Personal Opinions