MED-PEDS Board Review

1. MED-PEDS Board Review Welcome Review Course Format Multiple-Choice Questions 101 Shalini Chandra, MD, MS

2. Board review med/peds style Focus Focus Focus Focus on Content Specifications and/or Inservice Topics

3. Class Responsibilities • 1st year: Pulmonary • 2nd year: Rheumatology and GI • 3rd year: Nephrology/Urology, Heme/Onc, and Dermatology • 4th year: Cardiology, ID, Endocrine • Chief and attendings: end of section quiz • Format of the presentation is up to you

4. Basic Study Tips Nothing can replace effective study habits or knowledge about the subject being tested!

5. Things to keep in mind… • There are 3 kinds of studying… • Studying for your own understanding • Studying for your patients • Studying for the BOARDS! • Certain topics are favorites of test-writers. For medicine go through old in-service topics. For peds go through old in-service topics as well as content specifications.

6. In Hindsight… • Pick your study book early! • Don’t waste too much time or money reviewing too many books. Pick one or two and stick with them! • Some Medicine options: Mayo, CMDT, MKSAP, Hopkins • For Peds, Nelson’s is probably the ideal way to go if you start early, MKSAP is a great second choice, but bottom line is know the content specifications!

7. When you read… • Survey the chapter headings and subheadings • Try to think in terms of • Common etiologies • Classic clinical presentation • Preferred diagnostic tools • 1st, 2nd, and 3rd lines of treatment • Prognosis • Primary & secondary prevention

8. When you read… • Get a spiral notebook and take your own notes while reading the chapter • Summarize in your own words • Pick out the most important stuff • Make pictures, tables, mnemonics • Write down “catchy phrases” • Jot down things in triads or groups • Jot down classic features of syndromes

9. When you read… • Explain the concept to yourself or to someone else • Your grandmother should be able to understand your explanation • Ask yourself to explain the same concept the next day or a few days later

10. Test-Taking Techniques Multiple-Choice Questions 101 Develop skills which increase your command over the testing situation

11. How to be “Test-Wise” • To increase your chances of selecting the correct answers, you must: • Maintain control…Don’t Panic! • Think positive! • Use skill and forethought to analyze a test item before selecting an answer. • Remember you spiral notebook • Remember your lectures • TRUST YOUR RESIDENCY!

12. Break the question down into its components • First, glance at the last 2-3 lines of the stem…you might not need to read the entire stem! • Read the stem circling key words • Pay close attention to what the question is asking for • Cover the options, and come up with your own answer • Hopefully, one of the options will be similar to your answer

13. Break the question down into its components • First, glance at the last 2-3 lines of the stem…you might not need to read the entire stem! • Read the stem circling the key words • Pay close attention to what the question is asking for • Cover the options, and come up with your own answer • Hopefully, one of the options will be similar to your answer

14. Examine all options… • If you can find your answer great, BUT read through ALL the options! • An option may contain accurate information, but it might be wrong because it does not answer the question. • Look for “Not”, “Except”, “Never”, “Avoid”, “Contraindicated”, “Unacceptable”, “Unrelated”, and “Least” • If all the options appear correct, reread the question…you may have missed a negative word.

15. Identify key words in the stem that set a priority. • Look for words such as “first”, “initially”, “best”, and “most”. • These words modify what is being asked. • This type of question requires you to put a value on each option and then place them in rank order. • If you are having difficulty ranking the options, eliminate the option that you believe is most wrong among all the options. • Next, eliminate the option you believe is most wrong from among the remaining 3 options.

16. Peeking into a test-writer’s mind… • A clue is the unintentional use of a word or phrase that leads you to the correct answer. • A word in the stem may be identical or similar to a word used in the correct answer. • Make sure the grammar in the question fits the option

17. Identify specific determiners in options • Options with words such as “just”, “always”, “never”, “all”, “every”, “none”, and “only” are absolutes and usually wrong

18. Identify opposites in options • Sometimes there will be 2 options that are opposite to each other. When opposites appear in the options, either one of them will be the correct answer, or they will both be wrong • If you correctly evaluate opposite options, you can increase your chances of selecting the correct answer by 50%.

19. Identify equally plausible/unique options • Items sometimes contain 2 or more options that are very similar. • If 1 option is no better or no worse than the other option in relation to the statement presented in the question, chances are they are both wrong

20. Identify duplicate facts in options • Options sometimes contain 2 or more identical or similar components. • If identify 1 component as being correct, you usually can eliminate at least 2 options. • If you know insulin must be given, obviously any answer without insulin is wrong • If you don’t know insulin must be given, but it’s in three of the five answer choices, chances are the other two choices are wrong

21. Identify relationships…the center of attention • Analyze all the options and see if one option is related to all the others, especially if the others have no connection with each other…that’s likely to be the right answer

22. Don’t forget the teacher… • Some test writers like to teach through their question. Usually they tend to be a little verbose. If you think this is the case, pick the longest answer.

23. Identify options that deny feelings, concerns, or needs • Options that imply any of the following regarding the patient are generally wrong • everything will be all right • deny patient feelings • change the subject raised by the patient • turf responsibility to other members of the health care team

24. Practice Practice Practice! • Think positive! • Don’t over-read the question • Don’t get mezmerized by fancy words you don’t know…trust yourself! • Concentrate on the stuff you know…come back to the hard stuff • Make educated guesses… • Try not to just pick ‘C’ • Don’t say “Three Bs in a row…it can’t be B”

25. Why did you get that wrong? • You don't remember seeing that before…you never studied the topic or not well enough anyway…go back and re-read • The option you picked is true, but doesn’t answer the question…watch for best, first…etc…read each question carefully! • You chose a partially correct answer. Don’t miss all of the above, or questions that have components…read all the options!

26. Why did you get that wrong? • You misunderstood the concept…go back and re-read, recite and review. • You could not apply the concept to a new situation…you got caught in the twist…re-read, recite and review. • This is common especially for people who study only from test questions. • You misread or overlooked something in the stem, the question, the options…pace yourself-don’t rush!

27. Why did you get that wrong? • You over read the question…Remember the level of the test…esp. for Step 3! Some questions are straightforward… • If you know it’s right, pick it and stick with it! Don’t second guess yourself. • The option you picked is true, but doesn’t answer the question…watch for best, first…etc…read each question carefully! • You chose a partially correct answer. Don’t miss all of the above, or questions that have components…read all the options!

28. Why did you get that wrong? • You made a calculation error…esp. with stats questions…go slow and re-check your work • You fell into a myth trap…too many B’s or don’t pick all of the above…trust yourself and guess by elimination. • Bad question. Sometimes practice questions are questions that got rejected from the real boards. • Test anxiety. This is real. Practice at least one test in a “test-like setting” • If you have physical impairments or learning disabilities, apply for accommodations early! It can be a long process.

29. Test Day • Follow your regular routine the night before a test • Arrive on time for the examination • Bring the appropriate tools • Manage the allotted time to your advantage • Check your answers and answer sheet • Don’t save all your bubbling to the end

30. Now that we’re ready… Hi ho, hi ho, to board review we go….