Steven I McLaughlin DVM, MPH, DACVPM

Steve@Zukureview.comwww.Zukureview.com

1 800 928 8218

Study SmarterTM

Effective Study Strategies for the North American Veterinary Licensing Exam

(NAVLE ®)

“It is not enough to be a good chess player,

you must also play well.” -Savielly Tartakower

A StoryOnce 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 “DilatedCardiomyopathy”

One day, a good-hearted but near-sighted vet student wandered intothe Dog forest, and got so engrossed studying the bark on a single treethat 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

*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, 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 2009459-person increase in test-takers from accredited schools, same period

Reference: NBVME NAVLE results page http://www.nbvme.org/?id=82

NAVLE Pass RatesSenior 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 2009Marked decrease in test-takers from non-accredited schools, same period

Changes likely due to 2007 requirement to pass BSCE test prior to NAVLE

“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)

NAVLE Pass Rates What do they mean to me?

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 Structure72 (24%) Canine:72 (24%) Feline: 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

84% of the NAVLE

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 questionsand 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+QuestionsComputerized sample questions, tutorial http://www.nbvme.org/?id=80NBVME 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 SmarterTM

“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)

“I spent 6 hours reading endocrinologyon Saturday,…..

But Monday, I didn’t remember any of it !”

“Reading = Learning”

A study technique that doesn’t work

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 SmarterTM

• 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 NAVLEThe 50:50 rule

Goal: Finish study-mode tests, complete summary notes 4 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

NAVLE Study PlanFirst Pass

Monday: 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: ImagesA 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

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 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 feet3 “C’s” A. Candidiasis B. Cocciomycosis C. Cryptococcosis

3 “BAH, humbugs” A. Blastomycosis B. Aspergillosis C. Histoplasmosis

Map from 100 feet

3 “C’s” A. Candidiasis B. Cocciomycosis C. Cryptococcosis

Map on the ground 2. Cryptococcosis

a. Presentation b. DDX c. Test of Choice d. Treatment e. Prevention/Prognosis

You are here

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. 703Notes developed by senior veterinary student for educational use in preparation for NAVLEImage source unreferenced. May be used only for educational purposes

An example of good summary notes: Cryptococcosis

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: PharmacologyMap from 10,000 feet

5 “Antis”AntibacterialsAntifungalsAntiparasitics AntiviralsAntineoplastics

5 “keys”Key Cardio drugsKey Optho drugsKey Repro drugs Key Endo drugs Key Renal drugs

MiscKey antidotes/tox reversal agentsAnalgesicsTranquilizers

Map from 1000 feet

I. AntibacterialsA. ‘cidalsB. ‘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

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, 3 rd ed. p. 113Notes developed by senior veterinary student for educational use preparation for NAVLEImage 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, 3 rd 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 LitterTM

“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 NAVLE: 50% of your time

Multiple choice tricks of the trade

• The Good NewsCorrect answer is GUARANTEED to be among the choices

• The Bad NewsYou 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 periodgolden 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

• After 24 hours, most new info fades from memoryfades from memory

Sources of practice questionsFree• 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)

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

Pop 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

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”

Questions about prognosis tend to be all or nothing (ie: clearly GREAT or clearly HORRIBLE)

Prognosis/success rates by percentage:

Excellent 90-100% (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

• 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

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

Image courtesy, Dr. Peter Schantz

Where is the problem?

Tongue ulcer, canine leishmaniasis

Image courtesy, Dr. Kim Stanz

Where is the problem?

What is it? Ulcer, possible descemetocoele

Image courtesy,

Dr. TerriDefrancesco

Where is the problem?

What is it? Endocardiosis, mitral valve

Image courtesy, Dr. Scot Nachbar

What, if anything, is wrong with this picture?

HistoryHint: 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?

HistoryHint: This beagle was hit by a car

Upper left quadrant, Ilial fracture

Image courtesy, Dr. Terri Defrancesco

HistoryHint: 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

Online Case Study & Image ResourcesSurgery case studieshttp://www.acvs.org/AnimalOwners/HealthConditions/

Radiology case studies http://www.vet.k-state.edu/depts/VMTH/radiology/cow/index.htm

Radiology artifactshttp://vet.osu.edu/index.php?id=2355 Clin Path Case studieshttp://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

Merck images online http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/mvm_list_img.htm

Tech hint:

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

“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 weeksSecond Pass

The final 4 weeksSecond Pass

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 testingDo timed test-mode tests

-60-question tests build stamina-Random topics -No answers as you go-Mimics the real thing

• 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 4 weeksKeep a routine

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

“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!

ReferencesThe 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+QuestionsComputerized sample questions, tutorial http://www.nbvme.org/?id=80NBVME Self-assessments http://www.nbvme.org/?id=93&page=Self-Assessments