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STUDY GUIDE THE CRAMMER A CRAMMER’S GUIDE TO BOARD PREPARATION Cramming may not

STUDY GUIDE THE CRAMMER A CRAMMER’S GUIDE TO BOARD PREPARATION Cramming may not be optimal for exam preparation, but it may be inevitable. If the date of your certifica tion or recertification exam is fast approaching, and you are just beginning to study, there’s still time for you to benefit from a strategic approach. It turns out that you are in good company. People with high intelligence find out early in life that cram ming — an intense period of focused study shortly before an exam — can get them over most academ ic hurdles. Cramming is further ingrained by the “learn-and-dump” approach to teaching and testing during the first two years at some medical schools. The good news is that if you are actively engaged in clinical practice, you are learning constantly. Every day with your patients prepares you for boards, and each act of clinical reasoning is a rein forcement of your knowledge. As you move forward into studying, you can derive confidence from what you already know. With self-knowledge and the right tools, you can make the most of the time available. Advances in cognitive science have produced new understanding of how best to learn and study, with corresponding tactics to help even the most time-pressed studier. Better still, new study aids for physicians incorporate these techniques for efficient, targeted preparation. COMBINE “BEST PRACTICES” FOR STUDYING WITH COMMON SENSE For most of us, true lifelong learning and board preparation requires augmenting our knowledge with focused time to read and study. Even if you are only a few weeks from your exam, you can still integrate “best practices” with common sense ap proaches. Here’s how: Learn how to take the test: Knowing how to take a particular test is essential to a positive outcome and can be accomplished in a short time frame. For most boards, it is essential to practice with case-based questions and to master the art of multiple-choice questions. Take practice tests. If you haven’t taken a test recently, train yourself for computerized test-taking. Study with cases and case-based questions: You might think that studying via cases-based questions won’t cover enough ground fast enough for you. But case-based questions are a good use of your time — and not only because they make up the majority of most boards. Case-based questions engage your mind more actively than textbooks or lectures, and such “active learning” is deemed best for knowledge retention. The problem-solving we apply to a specific patient’s needs is how we learn in our daily practice. It also is consistent with the clinical reasoning required for a board exam, more so than a recitation of facts. Use the “blueprint” for your board’s exam to guide you: The American Board of Internal Medicine, for example, makes available online the blueprint that guides creation of its exams. In this case, the blueprint Call Us Toll-Free 1-855-318-9303 http://knowledgeplus.nejm.org 2 THE CRAMMER directs the percentage of questions in specific med ical content categories (i.e., 14 percent cardiology, broken down further into the number of questions about ischemic disease, arrhythmias, etc.) and in cross-content categories (i.e., 10 percent geriatric medicine). Studying in sync with the blueprint is time-efficient. Self-assess: How we think we’re doing — that is, our judgments about our own learning and memory — affects the outcome. Called “metacognition,” this ability to recognize your own strengths and weakness es helps you prioritize what to study. A practice test at the outset will help with self-assessment. Be honest with yourself about what you do and do not know. Then, consider a study tool that can quickly review the topics you know well — so you can focus your remaining time on weaker, but high-priority, areas. What doesn’t work: If your time is short, and you like the idea of cramming in a lot of learning at once, a review course may sound appealing. Unfortunately review courses are one-size-fits-all, tend not to adapt to your strengths and weaknesses, and lull you into thinking you must be learning when you’re not. As cognitive science has shown in recent years, passive learning is not particularly effective, and knowledge gained in a one-time, intensive review tends to decay rapidly in the absence of effective consolidation. Question banks: These have become an essential tool for board preparation, bolstered by evidence that answering questions and retrieving knowledge from memory actually boosts knowledge retention. Question banks appeal to Crammers who can work through a mountain of questions in an intensive study session. And they are useful for studying in short bursts, wherever and whenever you have a few free moments. Ideal questions require case- based problem-solving (for active learning) and are mapped to your exam blueprint. Use adaptive learning: The most effective question banks use “adaptive learning,” a technology that serves questions based on your prior responses. Algorithms determine which questions to present to you, depending on your past correct or incorrect answers. This creates a reliable “metamemory” to guide your study. The most sophisticated question banks move quickly through topics that you already know and make efficient use of study time by fo cusing on areas where you were once solid and can relearn quickly. Reflection: Reflecting as you learn is a key principle for maximizing study time. And it can be built into a good study tool. When you find out that you’ve just answered a question incorrectly, the negative experience tends to increase your attentiveness and create a powerful opportunity for new learn ing when your mind is most open to suggestion. When a question bank offers useful feedback after a wrong answer — and you read and process the information — you have capitalized on a learning moment. Call Us Toll-Free 1-855-318-9303 http://knowledgeplus.nejm.org 3 THE CRAMMER Call Us Toll-Free 1-855-318-9303 http://knowledgeplus.nejm.org 4 The power of repetition: Repetition is also important to create a strong scaffold for your learning. You may think you don’t have time to go over material more than once. But it has become clear that repeti tion and re-exposure to material is a powerful strate gy to consolidate learning and maximize retention. Avoid a linear plan: If you march through the cur riculum topic by topic, you may get stuck on a topic and run out of time before studying other key areas. Instead of covering just half the material at 90 per cent depth, you are better off if you cover 90 percent of the material at 50 percent depth in your first pass at it. This leaves you time to circle back to topics to reinforce and expand upon what you know. Think in pictures: Try to use a study aid that stim ulates the visual side of your brain to recognize clinical features of disease through radiologic images, photographs, and EKG tracings — which may appear in board exams. Pace yourself: You may not have the stamina that you had in medical school, and long study sessions probably are not the best for retention anyway. Short and repeated bursts of studying are optimal for learning. Embrace the process: With your intense focus, a Crammer tends to dive into the process of learning. That works in your favor. A positive attitude will take you far, and you may even find that new study tools are fun to use. With little time and a lot at stake, why not embrace the love of learning that got you into medicine in the first place? An alternative to cramming?: If you are still several months from your examination, you have time to re- think your self-definition as a Crammer. It is widely accepted now that the most effective learning occurs over time, called “spaced learning” or “distributed practice,” and is better than trying to learn a lot at once. For boards and for your practice, repetition and re-exposure are especially helpful for knowledge that is weak or was learned some time ago. Technol ogy can help you adopt this more deliberate learning style, to maximize your learning efficiency. STREAMLINE YOUR STUDY No matter how little or how much time you have to study, if you approach a test of generalized knowl edge such as the ABIM boards thinking that you must master every nuance, you’ll feel like you’re drinking from a fire hydrant. These suggestions will help to streamline your approach. What to study: • • Well-established treatment guidelines from national organizations for common diseases such as type 2 diabetes, hypertension, asthma, and hyperlipidemia. • • Screening guidelines, such as those for breast, colon, and cervical cancer. • • Specific physical findings that can be diagnostical ly useful, such as knee maneuvers and murmurs. • • Problems that are frequently encountered in a practicing physician’s office, such as sinusitis, depression, migraine, chronic pain, COPD, etc. • • Be ready to recognize un common presentation of common diseases, but only typical presentations of uncommon diseases. • • Anticipate common drug interactions. THE CRAMMER Call Us Toll-Free 1-855-318-9303 http://knowledgeplus.nejm.org 5 In the days before an exam, review common lists of facts: uploads/Geographie/ study-guide-crammer.pdf