Here's a second thing by far the people do that is a big mistake. They are passive. They phone it in on books and notes. What I mean by that is they don't take it seriously. They don't make it active. They just casually cast their eyeballs on some notes and they think they know it. That is not enough. That is not how you do it. Okay. There's some really interesting psychological studies that talk about exactly that phenomenon of like, if you give a bunch of men instructions on how to fix a toilet, say, can you fix this toilet? They're like, oh, yeah, totally. Most of them can't do it. That might be a gender thing. I don't know. We commonly see people, they don't even look at notes in books. They don't do any independent study. I'm embarrassed sometimes, people will email us, they're like, I don't understand this question, you have to explain it to me right now. It's like you need to go look it up. You need to go do a little research. I am not Doctor Google, I'm Doctor Zuku, okay? And I'm not saying this to be mean. I'm saying this because it works. When you look up something to find your own answer, it gets stuck in your head. It's really important. And yet some people don't even open a book. And the second sin is they don't quiz themselves about what they just read. That's the magic answer. Let me show you some cool examples. Okay. So what you do is when when you're not doing practice tests, try to pick up notes or make notes of your own, or open your book and look up that disease that's giving you a headache. You know which diseases give you a headache, right? Oh my gosh, I can't remember how to test for Cushing's disease. I mean, I can never remember that stuff. So go tune up on it. It's not sexy, but it works. If I could get people just to do this piece and to complete their material, more people would pass. 

Okay. So overconfidence bias I've been learning about this week, so I want to tell you about it. And how notes go wrong or how to do notes wrong. So you got Mr. Kitty here, and in his head, he thinks he's a lion. He's overconfident. He thinks he knows more than he really does. Okay. And there's been studies of this. It's called the Dunning-Kruger effect. And it's a it's a cognitive bias for people with limited knowledge or limited competence consistently overestimate their knowledge. It's a bona fide thing. It's been studied. And basically when they've tested people, the people with less knowledge than people have more knowledge, and people with the less least knowledge tended to overestimate. They thought they were smarter than they really were. And it's this phenomenon of, oh I read the notes, I know what's in there. You don't really know what's in there if you haven't done something active. Okay. I couldn't resist. Here's a cool cartoon from Joost Verweii, she's a web designer. My IQ is higher than yours. I mean, he might be higher there, but he doesn't know as much as he thinks he does. Okay. This bias appears to be based more on ignorance, the arrogance, and it turns out, the solution, and it doesn't matter whether you're a psychologist or a physician or a judge. Doesn't matter. The solution is accurate feedback. The solution is if you own, oh, I didn't study as hard as I should have. That's accurate feedback. If you read something and quiz yourself on it, the quiz is the feedback. Okay? This is why practice testing is such a powerful learning tool. Because you get immediate feedback, did I get it right or wrong? And if you get it wrong, we all hate that we shrink a little bit, but we remember it. And the next time we see that question, we're going to get it right. The same thing works with notes. If you can build a habit of quizzing yourself after you read a notes sheet. You can make it active. You can change your notes review or your book review from active to passive. It's a it's a super great trick. It works really well. It's a simple as just I mean, I would I walk around the room, I read my notes on whatever, pancreatitis, and I close my eyes and I ask myself, okay, how do I what's it, what's the case look like? It's a puking, middle aged female. Interesting. Okay, fine. How do I test for it? I don't remember, you guys have to tell me. It's lipase amylase or something like that. I'd have to look it up. How do I treat it, you know, but that's that's what you ask yourself. It's always the same thing. Okay? I'm having trouble getting my little thing to go. 

There we go. All right, so, I want to just show you some examples of notes. And what notes can do for you. You know, any notes that you write in your own hand are worth a lot more than notes that I write. But if time is short, take notes that you got from your own school. From vet prep from Zuku, I don't care. At least make it an active process. This is just a picture, I used to draw a lot of cartoons on my notes. This is a picture for when I was preparing for my preventive medicine boards. That's, EPAC, enteropathic E.coli, infantile diarrhea. These are some notes from a, veterinary student that I've interviewed. Her name is. What's her name? Doctor Savannah. I have to go look it up now. This is somebody who likes notes, likes colors, and goes to a lot of trouble to make her own handwritten notes. As a person who loves notes, I'm a big fan of that. Problem with writing your own notes is it takes a long time, but man, you don't learn it. You really learn it when you write your own notes. So I would say if you have a few diseases that are driving you up the wall. Write your own notes. These are just some old toxicology notes from a million years ago. But whatever it takes to make it stick in your head. 

\ Okay. Sticking a picture in your notes, it's like mental duct tape. That little weird cartoon of the baby, the rattlesnake. Whatever it is that works for you. But sticking pictures helps, and it's easy to get pictures online now. Okay. To that picture, you can hang information. Here you can see the floating lungs of pleural effusion. They're floating up on the top of a lake of fluid in the chest. Okay. Does that trachea normally have to go way up like that? No, the trachea should be straight. Those are floating lungs. Here's pulmonary edema. They're heavy. They're wet, and they're so wet that they're obscuring the x ray. You can barely see the silhouette of them. Okay. So get those notes in. Get those images in your notes. Here's some more examples. Here's a case where Doctor Savannah made IMHA notes. As you can see they're, she's just distilling. She got a picture. Really nice picture, actually, of what a CBC on IMHA looks like. What's a classic case? Pallor, weakness, collapse, dyspnea, icterus, you name it. Maybe sudden death. Treatment, or differential. This is how you diagnose it. Treatment is basically going to be things like, transfusion, fluids, maybe some immunosuppressants, things like that. Okay. What are we looking at here? Well, let's just have a look. These are some notes. This happens to come from zuku. Same disease, these are notes we wrote, but same idea. What's a classic case look like? What's my, how do I diagnose it? How do I treat it? It's always the same. So what would you do? What you do is you. You read these notes, and then you close your eyes and you ask yourself, what does a classic case look like? They're lethargic. They're pale. They might be collapsed. You may or may not have icterus. Okay, fine. How do I treat it? Let's see. Immunosuppressants. Maybe a transfusion. Supportive care, monitor. Something like that. Is that what it is? I get close, okay? I mean, you're not going to get it right the first time. You got to repeat this over and over and over. Okay, fine. How do I diagnose? Let's see. How do I diagnose? I think I want a CBC. Give me a CBC. Sure enough anemia. Okay, here's your PCV tubes. Very anemic. Kind of icteric. What do I see on my, CBC? I see anisocytosis, so different sized cells. I see, polychromasia. I see these purple cells. I see spherocytes, red cells that don't have the central power. Okay. Is that everything you want to know about IMHA, no, but you're in the ballpark. You're making your act. 

Okay, here's just another one feline leukemia. You know, classically, these are, younger animals. You often hear history of free roaming, often male, and they come in with ADR, they ain't doing right. They just have these general signs. You don't even know what it is. You may or may not have abdominal muscle masses that you can palpate. You know, any stray or young animal that has not been tested for feline leukemia, how am I gonna diagnose it? I'm gonna do a feline leukemia test, and I'm going to slap on an FIV test while I'm at. Okay. Treatment, basically supportive treatment, decrease stress. These these cats can live a long time, but you have to keep them separate from FVLD negative cats. Okay. So you review those notes and then you just literally ask yourself what is classic case look like. And you close your eyes. So what's classic case look like, everybody? Young cat, free roaming, often male maybe a stray. Never been tested. No vaccines. I'm testing. Okay, great. Treatment supportive. Testing CBC feline leukemia and FIV test. You screen it, remember? Remember, these tests are kind of cool from an epi point of view. We screen for feline leukemia with one test. If it's positive, we do a confirmation with a different format of test. That's a common way, right, that we use, two stage testing to confirm these difficult to diagnose diseases. Okay. So that's how you use notes when you study, you don't just casually look at it and say you knew it. You do something. You write the notes for diseases that give you trouble. You quiz yourself every single time you look at them. Okay.