Study Smarter

TM

Effective Study Strategies for the North American Veterinary Licensing Exam (NAVLE )

Steven I McLaughlin DVM, MPH, DACVPM Steve@Zukureview.com 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

Todays 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
Fall 05-Spring 06 Fall 06-Spring 07 Fall 07-Spring 08 Fall 08-Spring 09

Pass
95% (2549/2686) 96% (2724/2841) 97% (2816/2903) 97% (2908/3009)

Fall only*
Fall 06 Fall 07 Fall 08 Fall 08

Pass
88% (2300/2616) 90% (2486/2760) 92% (2605/2828) 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
Fall 05-Spring 06 Fall 06-Spring 07 Fall 07-Spring 08 Fall 08-Spring 09

Pass
41% (534/1312) 41% (628/1546) 54% (370/680) 64% (481/757)

Fall only
Fall 06 Fall 07 Fall 08 Fall 08

Pass
44% (308/698) 44% (352/799) 51% (242/476) 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 dont 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 Suttons 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 DONT do all 200 questions in one sitting
DO 10-15 questions per day look up answers to the ones you dont 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
many hours you study.

TM

Successful learning is not measured by how

Successful learning means using the hours you do have effectively.

-Dr. Zuku
(Steven I Mclaughlin DVM, MPH, DACVPM)

A study technique that doesnt work

I spent 6 hours reading endocrinology on Saturday,..
But Monday, I didnt 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 doesnt 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
Start with a calendar

TM

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%
-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 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

DONT 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

Horners 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
http://commons.wikimedia.org/wiki/File:Horner% 27s_syndrome_dog.JPG

What is it?
Image courtesy, Dr. Joel Mills, Wikimedia Commons

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 Cs 3 Cs 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, Tschauners 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 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

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). Dont use alone or see rapid resistance 3). Give on empty stomach e.Mental velcro- Rhodococcus equi

References: Plumbs 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 mans best friend.

Inside a dog, its 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: *Plumbs 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 dont 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 (DONT 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 whats left, and MOVE ON

What if I dont 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 Vet video library: www.vetvideos.com

Right-click your mouse over an internet image, to copy and paste it elsewhere

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. 2. 3. ~50% study, ~50% practice testing Redo missed questions w/in 24 hours 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; dont 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