Testing . . . Testing . . . 1,2,3

1. Testing . . . Testing . . .1,2,3 Nancy F. Barrett EdD August 25, 2008

2. Strategies to be Successful Test Takers • Strong medical knowledge • Good written English skills • Familiarity with the test’s computer process • Attend to logistics before and during exam • Employ test taking strategies by: • Looking for medical knowledge clues • Looking for wording clues • Employ effective stress reduction strategies

3. General Characteristics of ITE, Step 3 and ABFM Exams • Test of overall medical knowledge • Written by practicing physicians • Use clinical scenarios • Both inpatient and outpatient settings • Heavily oriented towards Adult Medicine (see 07 Aggregated Results hand out)

4. 1. Increasing Medical Knowledge • Review In-Training results and rotation evaluations. • Develop an education plan to address deficits. • Use evidence based resources to read about patient cases. • Set aside some time each day to read on a case or specific medical concept. • Use resident presentations to address an area of interest/need. • Develop a clinical poster or presentation Organize a study group if you learn well that way • Participate in Board study sessions sponsored by the residency. • Ask questions of your preceptors!

5. 2. Fluency in written English • Review old ITE exams and note any terms or concepts that are problematic. • Review your evaluations and note any communication issues noted by attendings. • If you have concerns, ask for help.

6. 3. Familiarity with the Computer System • Use the practice tests provided by USMLE • Review list of sites recommended by other residents. • Take the time to familiarize yourself with the system and expectations before the exam!

7. 4. Logistical Issues—BEFORE the Test • Arrive early at the testing location, preferably the night before • Find the location the day before the test, including where you will park, where the test center is, where you can eat lunch • Get a good night’s sleep prior to the exam • Restrict fluid intake • Restrict caffeine intake • Use the restroom prior to the start of the test, since you will not be able to leave. • Identify stress reduction strategies that work for you. (eg: breathing deeply, closing your eyes for a moment, stretching in your chair) • Turn off your cel phone • Be familiar with testing guidelines.

8. 4. More Logistics • Wear comfortable clothing and shoes • Bring a jacket • Dress in layers • If you wear contacts, bring a pair of glasses. • Bring gum or mints, if allowed by the testing center. • Bring Kleenex and cough drops. • Bring a wrist watch to keep track of time.

9. 4. Getting Started • Allow yourself a minute to release panic or stress • READ AND FOLLOW THE DIRECTIONS • Preview the test (as possible) • Keep moving-don’t get bogged down on a question • Keep track of time-remember: you have about a minute per question!

10. 5. Test Taking Strategies-General • Eliminate obvious wrong answers • Eliminate highly implausible answers • If an answer seems obvious, choose it • Go with your first instinct, unless subsequent review shows you made an obvious mistake (your first instinct is usually correct)

11. 5. Test Taking: Medical Clues • History, especially recent travel • “Magic” words like ethnicity, geography or occupation. eg: Cambodian origin for rheumatic heart disease • Epidemiological fit (lupus and young female) • Abnormal findings • XRays, MRI’s or lab results • Medications list and Black Box warnings • When asked for the next step, think emergency!!

12. 6. Test-taking: Clues in Questions In the question stem: • Note key words • Devise a response before reading options • Eliminate choices that do not agree grammatically • Examine common wording in stem and alternatives • Not in a question reverses the meaning.

13. 6. Clues in Answers • Specifically note words like except and not • Summarize complex questions • Select choices that have opposite meanings • Avoid choices with always or never • If confused, turn options into true-false statements • Longest option is likely to be correct • If two answers are the same except for one or two words, one of them is probably correct • If two choices appear correct, choose the one that causes the other • Always pick the most inclusive answer

14. 6. Most Likely Correct Responses When in doubt, choose . . . • Middle choices (b or c) • Middle numerical value • All of the above, none of the above or two of the above

15. Conclusion • Address medical knowledge • Have a good grasp of written English terms • Be familiar with the computer process • Attend to logistics before and during the exam • Employ test taking skills by: • Looking for medical knowledge clues • Looking for wording clues • Use effective relaxation strategies before and during the test. (will address later)

16. Sources • Kelly, K. (1999). Taking the boards? Try these strategies for success. ACPOnline www.acponline.org/journals/news/may99/boards.htm Accessed 1028/05. • Carlisle, K. (1985). Learning how to learn. Training and Development Journal. March. 75-80. • Long, E. (2000). Conquering test writing anxiety. Toronto: Irving Publishing. • Ludwig, C. (2004) Preparing for certification: Test-taking strategies. Medsurg Nursing 13;2 127-8. • Steenburgh, J (2003). Strategies to help pass the internal medicine boards. ACPOnline www.acponline.org/journals/news/june03/boards.htm Accessed 1028/05. • Weinstein, C. and Goetz, E., eds. (1988) Learning and study strategies. San Diego: Academic Press Inc.