Study SmarterTM

Effective Study Strategies for the ECFVG Basic Clinical Sciences Exam (BCSE)

Steven I McLaughlin DVM, MPH, DACVPM

Steve@Zukureview.comwww.Zukureview.com

1 800 928 8218

“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 “Pharmacology”; another “Physiology” and so on.

In the Pharmacology forest, there were many trees. One tree was called “Antibiotics” and another called “Antiparasitics”.

On that antibiotics tree was a single leaf called “Rifampin”

One day, a good-hearted but near-sightedvet student wandered into the pharmacology forest, and got so engrossed studying a leaf on a single tree that she got lost, and a bigbad wolf called BCSE 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

This presentation

• BCSE Structure

• Study strategies for BCSE

• Test-taking strategies BCSE

BCSE Structure• 225 Multiple choice questions

• One continuous 225-question block– 220 minutes (almost 4 hours!)– ~1 minute per question– “Many with graphics”

• 25 questions are “pre-test” items– Not scored– Cannot tell which questions are “pretest”– Presumably being evaluated for use in future BCSE exams

• No breaks once you start

Source: http://www.avma.org/education/ecfvg/bcse_bulletin.asp#intro

BCSE Pass Rates

To date, the ECFVG has released no data

on the numbers of people taking BCSE or the

numbers passing

Source: http://www.avma.org/education/ecfvg/bcse_bulletin.asp#intro

?

BCSE Topics: Not exactly “laser focused”

1) Anatomy 18-22 Qs (~9%)

2) Physiology, Pharm., Tox. 24-28 Qs (~12%)

3) Pathology 22-26 Qs (~11%)

4) Medicine 42-50 Qs (~20%)

5) Surgery and anesthesia 34-38 Qs (~16%)

6) Diagnostics 26-30 Qs (~12%)

7) Preventive medicine 18-22 Qs (~9%)

BCSE is like a “mini-NAVLE” “….designed to assess basic and clinical veterinary sciences knowledge. The knowledge level expected ……of an entry-level US veterinarian (ie, new graduate of an AVMA-accredited veterinary school) .”

Source: BCSE Candidate Bulletin http://www.avma.org/education/ecfvg/bcse_bulletin.asp#outline

Worth Remembering on Test Day

• Must show up 30 minutes early– Must have Authorization to Test (ATT) letter w/ unique i.d. number – Must have TWO forms of identification

• Photo-i.d. with signature, and name (ie: driver’s license, passport)• Secondary i.d. with signature

– Name on BOTH i.d.s must match ATT name

• 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

Source: http://www.avma.org/education/ecfvg/bcse_bulletin_pf.asp#identification

Why bother to study effectively ?

• BCSE is foundational knowledge– Concepts support your NAVLE prep – AND help you in clinics

• Use motivation of BCSE to learn how to learn(This isn’t the last test you’ll ever take….)

• Who wants to waste time and money taking this test more than once?

Example of a BCSE-style question

Which stage of the canine estrous cycle is

characterized by > 90% cornified epithelial

cells with pyknotic nuclei and a lack of neutrophils in

a vaginal smear?

(A) Late diestrus

(B) Late estrus

(C) Early diestrus

(D) Early proestrus

(E) Anestrus

Source: Merck Vet Manual http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/181903.htm

Remember: "CORNflakes go with MILK." Think > 90% CORNified, superficial cells in canine estrus (angular, sharp edges like corn flakes, tiny pyknotic nuclei or no nuclei, no neutrophils). Full cornification usually coincides with receptivity.

Follow this link to see a vaginal smear from a dog in estrushttp://www.merckvetmanual.com/mvm/htm/bc/mgnrs905.htm

and in diestrushttp://www.merckvetmanual.com/mvm/htm/bc/mgnrs903.htm

Example of a NAVLE-style question

You are assisting a dog breeder decide when to breed her prize Siberian mousehound.

A vaginal smear looks like this:http://www.merckvetmanual.com/mvm/htm/bc/z-mgnrs905.htm

What would you recommend to the owner ?

(A) Cannot say from this slide(B) Cannot say with only one smear(C) Breed the dog today(D) We missed her estrus, wait 2 months(E) Not in heat yet

Source: The Zuku Review, online veterinary test prep http://zukureview.com/index.php and the Merck Manual online

If the BCSE is so broad, where do I start?

Be guided by BCSE example questionshttp://www.avma.org/education/ecfvg/bcse_practice_test.asp

– A springboard to study

– A pointer to key topics

– Gives you a sense of the depth, style of questions

Note: BCSE questions are similar to the QE. For more practice, try the PAVE QE practice test . http://www.nbvme.org/?id=35&page=QE+Sample+Questions

Where to start? An example

Which of the following changes occurs asa result of metabolic acidosis?

(A) Oxygen-hemoglobin saturation curve shifts to the left(B) Plasma becomes hypotonic(C) Plasma ionized calcium concentration increases(D) Serum glucose concentration increases(E) Serum potassium concentrations decreases

Source: Example from PAVE QE practice test, similar to the BCSE http://www.nbvme.org/?id=35&page=QE+Sample+Questions

Suggests “physiology & acid base” worth a review

Which of the following is the most likely finding

on a leukogram from a cow with a large

chronic abscess?

(A) Monocytosis with left shift and toxic change

(B) Neutropenia and eosinopenia

(C) Neutropenia and monocytosis

(D) Neutropenia with left shift and toxic change

(E) Neutrophilia and monocytosis

Source: Example from PAVE QE practice test, similar to the BCSE http://www.nbvme.org/?id=35&page=QE+Sample+Questions

Suggests “Clin Path / white cell function” worth a review

Where to start? Another example

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 endocrinology

on 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 3 weeks before test– All study-mode tests – Write out summary notes

• Second Pass: during the 3 weeks before test– All test-mode tests– Review summary notes

Study strategies for BCSEThe 50:50 rule

Goal: Finish study-mode tests, complete summary notes 3 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

BCSE Study Plan: First Pass

Monday:

Tests: ClinAnat #1,DxImaging #1,Pharm #1,Surg#1, Physio #1 etc.  Note mistakes. ~1 hr

Study: Quick read of 5 key disease topics ~ 1 hour

Tuesday: Tests: Do My Missed Questions from yesterday to reinforce

Start new tests- ClinAnat #2,DxImaging #2,Pharm #2,Surg#2, Physio #2 etc.

Study: Write summary notes on the 5 topics ~ 2 hours

Wednesday: Tests: Do My Missed Questions from yesterday to reinforce

Start new tests-ClinAnat #3,DxImaging #3,Pharm #3,Surg#3, Physio #3 etc.

Study: Quick review of summary notes from Tuesday

Quick read of 5 new disease topics ~ 1 hour

…………..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

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

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

“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 BCSE: 50% of your time

Recommended books for BCSE For medicine and disease summaries:Bovine: *Guide to Bovine Clinics 4th edition—Chris & Susan PasquiniEquine: *Guide to Equine Clinics 3rd edition—Chris & Susan Pasquini, Phil Woods

Dogs and Cats: *Veterinary Clinical Advisor, Dogs and Cats, 1st ed. Cote' ed.*Tschauner's Guide to Small Animal Clinics 2nd ed.—Chris & Susan Pasquini Blackwell's 5 Minute Veterinary Consult, Canine-Feline 4th ed. Tilley & Smith eds.

Clinical Anatomy: Anatomy of Domestic Animals 10th edition— Pasquini, Spurgeon and Pasquini– On almost every page you find a box that tells the clinical significance, diseases associated

with that part. Superb. Study those. Make short notes. Go fast.

Pharmacology: *Plumb’s Veterinary Drug Handbook, 5th edition, Donald C. Plumb – The original and a favorite, available as a book or online through VIN

Physiology: Veterinary Physiology, 4th ed. Cunningham and Klein – Good case-based organization, FAR easier to navigate than Duke’s

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.

Anesthesia, dentistry, basic surgery: Clinical Textbook for Vet Techs, 7th ed, McCurnin & Bassert – Great images, good tune up on basics.

*Zuku Review Pick of the LitterTM

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.

Sources of practice questions

• BCSE sample test http://www.avma.org/education/ecfvg/bcse_practice_test.asp

• QE sample test (similar to BCSE) http://www.nbvme.org/?id=35&page=QE+Sample+Questions

• Vet Board Games cards http://www.veterinaryboardgames.com/

• Zuku Review BCSE course, Question Archive http://zukureview.com/QOD_Archive.PHP

• CAPC parasitology test http://www.capcvet.org/other/resources.html

• Mosby’s Basic and Clin sciences questions

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

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 3 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

The final 3 weeksSecond Pass

• 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 3 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 3 weeks before test

4. In final 3 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.

ECFVG Candidate Bulletin http://www.avma.org/education/ecfvg/bcse_bulletin.asp

BCSE practice test http://www.avma.org/education/ecfvg/bcse_practice_test.asp

QE practice testsText version: http://www.nbvme.org/?id=35&page=QE+Sample+QuestionsWeb version: http://nbvmepractice.starttest.com/

Extra slides

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 preparation for NAVLEImage source unreferenced. May be used only for educational purposes

Another example of good notes

Budin's rule states that the amount of cow's milkconsumed per day for a bottle-fed baby should beapproximately               of the weight of the baby.

A)   1/10             B)   1/8  C)   1/7         D)   2/10

Another Example of Convergence

A, B and C are similar: they have “1” in the numerator;

A and D are similar: they have “10” in the denominator.  A test-wise examinee will choose A because it appears in both sets above.  The correct answer is A.

Budin's rule states that the amount of cow's milk consumed per day for a bottle-fed baby should be approximately               of the weight of the baby.

A)   1/10             B)   1/8  C)   1/7         D)   2/10

Multiple choice tricks of the trade:Convergence

Adapted from: Leo M. Harvill, Ph.D. “The Test Of Obscure Medical Information”