David M. Cline
Excellent test performance requires both well-planned study methods and carefully applied test-taking skills.
EXAM PREPARATION AND PHYSICIAN PERFORMANCE
Exam preparation techniques and successful test completion have not been well studied within the specialty of emergency medicine. Studies from other medical specialties or professional disciplines may or may not pertain to emergency medicine board exams.
There is only weak evidence to suggest that continuing medical education positively impacts clinical practice.
Interactive sessions that emphasize practice skills may have a positive impact on physician practice behaviors.
There is little evidence that routine didactic educational conferences improve test performance.
It has been shown that an intensive conference series focused on exam content can improve subsequent test performance.
It has been shown that increased conference attendance by surgery residents improved test performance for residents with higher past performance histories.
Studies conducted in other specialties have shown several factors that correlate with better test performance: self-directed study, programmed textbook review, and individual resident effort.
In the specialties of both neurology and surgery, past performances on the in-training exam predicted performance on the certification examination.
For surgery residents, being on call the night before the exam did not affect in-training exam scores.
STUDY TECHNIQUES
The following techniques are recommended based on commonsense rules of study methods. Supporting studies in emergency medicine have not been conducted.
Begin by setting a schedule to accomplish your study goals and objectives in the time remaining prior to the test. Allow time for reading this book, using a question-and-answer book to uncover any gaps in your knowledge base and your final review. Your schedule should be written and checked often to document your progress.
Find a place to study that facilitates concentration, not distraction. It has been shown that a single place of study improves test performance for college students.
Begin reading each chapter by glancing over the topic headings to get an overview of the material.
Formulate questions in your mind such as:
1. What etiologic information will help me to identify the patient at risk for the disease?
2. What pathophysiologic concepts will help to treat the disease?
3. What clinical features will help me to identify the disease?
4. What criteria confirm the diagnosis of the disease?
5. What are the recommended treatments for the disease?
Reading should be an active experience. Don’t turn the exercise into a coloring contest with your high-lighter. Write in the margins, circle, underline, and identify key points.
Review your notes and key points at the end. If you find the material confusing or your understanding incomplete, you will need to go to other sources for additional information, such as the parent textbook for this review book: Emergency Medicine: A Comprehensive Study Guide, 7th ed. Consider also reviewing a pictorial atlas of disease, an electrocardiogram atlas, and a radiology atlas.
If you do not have time to read this book in its entirety, review the index to identify gaps in your knowledge. Look for unfamiliar topics or disease-specific treatments you have not previously reviewed.
Last-minute cramming is an inefficient study method, taxes your energy, and creates anxiety.
PREPARATION IMMEDIATELY BEFORE THE TEST
Get plenty of sleep the night before the test.
Arrive at the test site well in advance of the start time to make sure you know where the exam room is located and become familiar with the surroundings and/or the computer-based testing procedure.
ABEM written exams are conducted at Pearson VUE testing centers; a tutorial can be taken ahead of the exam online: www.pearsonvue.com/sponsors/tutorial.
A tutorial is available before the actual timed testing session. You should take this tutorial because it may familiarize you with the procedure and does not take time away from the timed testing procedure.
In addition to those tutorials discussed above, an optional, 20–25 question demonstration test can be taken at the computer center at a date prior to the appointment for the actual test. There is a fee for this experience, and its purpose is to familiarize candidates with the computer-testing experience. The content and the level of difficulty of this exam experience are not intended to be representative of the actual test.
Check the temperature of the exam room so that you can anticipate proper attire. Dress comfortably.
Schedule enough time to wake up, dress, and eat an unhurried breakfast.
Eat an adequate but not heavy breakfast. Do the same for the lunch break.
Bring a photo ID to identify yourself and any other specified materials.
Although anxiety reduction techniques have long been recommended, a certain degree of test anxiety has been shown to improve test performance.
TAKING THE TEST
Listen carefully to any verbal instructions and read completely any written/on-screen instructions.
You have between 1.1 and 1.3 minutes per question on the test. Make sure that you maintain this schedule. For example, at the 1-hour mark, you should have answered approximately 60 questions. However, the pictorial stimulus portion of the test is usually first, and these questions take more time than the remaining questions for most test takers.
There is no penalty for guessing on this multiple-choice exam. Each question is worth 1 point.
You should answer each question as you work your way through the test the first time, selecting your initial best answer. The program allows you to flag the questions that you wish to return to and reconsider your answer.
Carefully read the question stem and anticipate the answer before you read the options listed. If you see the choice you anticipate, that answer is most likely correct.
Read all the answers to check for a more complete or better answer than the one you anticipated.
Don’t waste excessive time on a single question that puzzles you. Simply make your best guess and move on. The computer program facilitates flagging questions so that you can return to the question at the end for further consideration.
Remember that up to one-third of the test is not scored (see Chap. 1). If you don’t know the answer or find the question confusing, it may be a trial question. Don’t lose your confidence or your momentum.
Identify the incorrect options quickly so that if you are forced to guess, you have a better chance of being correct.
On items that have “all of the above” as an option, if you are certain that two other answers are correct, you should choose “all of the above.”
Options that include broad generalizations are more likely to be incorrect.
There is no evidence to support the idea that option “C” is more likely to be correct than others on ABEM exams.
Use every minute of the test time. If you have time left over, review first the questions you have identified as difficult, and then use the remaining time to reread the questions, looking for any misinterpretations that may have occurred the first time through.
Contrary to popular opinion, your first guess is no more likely to be correct than a carefully considered reevaluation of the answer. If during the review process, you find a better answer to a question stem, do not hesitate to change your choice. You have a 57.8% chance of changing a wrong answer to a correct one, a 22.2% chance of changing a wrong answer to another wrong answer, and only a 20.2% chance of changing a correct answer to an incorrect one. However, students who have a past record of doing well on exams are more likely to make a correct change than those students who have a history of poor test performance.
Do not spend your lunch break discussing specific test questions with colleagues. This practice could disqualify you from the test, and creates more anxiety, further limiting your performance in the afternoon.
Relax. The odds are in your favor, and now that you own this book, you have a concise means to review the practice of emergency medicine.