Steven I McLaughlin DVM, MPH, DACVPM
23 minutes

Evening, everybody, this is Dr. Steve McLaughlan, and our topic today is when time is short. NAVLE® study strategies for the home stretch. We're going to talk about a number of topics covering things you can do when time is short to get the most bang for your buck in terms of study time and effective learning. So without further ado, off we go.


"To achieve great things, two things are needed, a plan and not quite enough time" - Leonard Bernstein. So this is not news to any bad student anywhere, right? There's never enough time and there's always too much to learn. People talk about having to sip from the fire hose, and that's really what that school is like.


The name of the game is not to learn everything. The name of the game is instead to triage the information, pick out the big stuff, try to get a handle on that and keep moving. OK. Today, we're going to cover four major topics, but basically it'll boil down to this if you're NAVLE®'s next month, here's three things you can do. We'll just go through a couple of easy things anybody can pay attention to to make it more effective when you do study.


OK, we'll also talk about strengthening your memory with cases, your working memory, which is how we get stuff to stick and make it available in our heads throughout. We'll be practicing strategic test, taking essentially how to guess effectively when you don't know the answer because it's guarantee you're going to have some questions where you don't know the answer. That's normal. OK, and then finally, we're going to wrap up and review what are NAVLE® questions really like, because they may not be quite what you expect if you're expecting every single question to be, what's my diagnosis? Some may be that way, but you can expect things that are asking more of you, much as you will see in real life, where you're presented with a case and you have to figure out what you're going to do. OK, so that's our topic for today. And the first topic is if NAVLE®'s next month, what am I going to do?


So if NAVLE® is next month and you are anxious, you are normal. OK, I want you to know you're not alone. Everybody is feeling anxious when the test is looming like that and you're in good company. It's very normal. It's OK. You do not need one hundred to pass this test, you basically need to see if you can get 70 percent of the three hundred questions that count correct on your boards. Then you should be very likely to pass the actual number varies a little bit each year, but it's typically 70 percent of the questions that count. OK, throughout this, to the extent you can try to foster a realistic, pragmatic tree like attitude, OK, the name of the game is not to obsess over every detail that will that won't help.


The name of the game is try to give your best attention to the big stuff. Learn the key things you want to know about the key diseases, maybe three things. What's a classic case look like? Is there a test of choice? How am I going to treat? And then move on to the next disease. OK, you'll be going back over and over to review things, but you have to start with triage. So here are the three effective things that will help the most, number one, try to do timed tests every day in the final month or so, OK, and that means there's a clock ticking on your screen. You don't see the answers as you go and you're going to have random topic questions thrown at you so you might get a hamster question and then you have a horse question and then maybe it's a pharmacy question and then maybe a dog question.


OK, by doing this, you're reinforcing things. You've been studying now for many months and. You're building your stamina and your familiarity with the format, you're basically inoculating yourself to what you're going to feel on the day you take your test. Over the years and we've been doing this now more than 15 years. When we look at people who came very close to passing their boards but didn't quite do it, people that struggled. Across the board, the most common thing all those people share, they don't leave time at the end to redo their questions in timed testing, whatever service you're using, this is something that will help hand in hand with doing timed tests in the final, let's say, five to seven weeks. This is also when you're reviewing your books and notes on cases with images. Even if you studied like cats really intensely three months ago, you need to go back and review your top 15 or 16 cat diseases and just refresh your memory. OK, so maybe that's a third of your time. Plus two thirds of your time is doing testing, but that re reviewing. That redoing your questions and time test mode, it's reinforcing stuff that you really want at the front of your mind when the day comes to take your test, finally, outside of study, prioritize exercises, sleep.


I'm about to cover these three things a little bit more in detail. But if you had to leave the room right now, this is your basic recipe for how to spend your final month, OK? So the single biggest mistake that people make before a really big test, like a big standardized high consequence exam, like The NAVLE®, or the BCSE or the CPD, any of these big veterinary tests, the number one thing is people don't do enough time to practice testing at the end.


As I mentioned before. Year in, year out, this is the single biggest problem we see among people that have to retake their exam. They really worked hard on their study mode questions. And they never saved enough time at the end of due time tests, and there's even beyond whether using Zuku or VetPrep, there's even another way to do time tests that can help you. And I'll mention that just a minute. So how do you divide your time? Well, what we've seen over the years is that most people seem to do the best if they give about two thirds of their study time in any given week. To doing practice, testing, whatever tool you're using, be doing practice tests, because this is what you're going to do on the day of your exam. Study is what you do in the other third of your time where you make them review notes, you hit the books, you quiz yourself, work with friends, have them quiz. You have to teach a subject, maybe make little game cards, whatever it is. But it's about one third study getting the books, two thirds doing practice questions, OK, and just try to remember you're not just going to do this once.


You're going to do your practice questions and your review. For several months leading up to your exam and in the final month, you're going to redo all that again, you're going to redo the questions in time mode and you're going to review your notes. It's that repetition that makes the difference. I mentioned there is another way to do time tests, and this is it, many of you by now have probably heard about the ICVA self-assessment tests, the ICVA. These are the people that write the Natalie themself. Themselves. These tests are study gold, these are retired NAVLE® questions that are no longer being used on the NAVLE®, but the ICVA people thought that those particular questions were so valuable and so representative that they preserve them and put them in a self-assessment test. OK, this is straight from the horse's mouth. One of these tests cost fifty dollars. It has two hundred questions in it. And once you sign up, you have about 30 days to use it with a certain number of minutes usable within that 30 days.


OK. Over the years, what we've seen and they validated it statistically. If you do one of these tests within about two weeks of your actual NAVLE® test, it'll give you a pretty good barometer of how you're going to do OK within a range. But even more valuable than that, if you were to sign up for one of these things months in advance and just use it as a study tool, I think it's very useful that way. I mean, maybe you do 10 or 15 of those questions each day and out of 15 questions, maybe there's four or five, you just simply don't know. No problem. Just make it your homework that day to scribble out a few rough notes about the one to give you trouble, what it was. And then later that day, while it's still fresh in your mind, go to your good friend, Dr. Google, go to the Merck manual online and quick and dirty. Just try to see if you can hone in on what that question was about. It's not that you're going to see this exact question on your NAVLE®, but if the ICVA thought that this question and this topic was so valuable that they saved it and they put it in a self-assessment, that is an enormous wake up call to you. That probably that disease is worth your time to study up on, it's a big red flag. "Oh, maybe I need to know a little bit about each type periodic paralysis and horses or. Oh, maybe I need to know a little bit about. Vitamin C deficiency in guinea pigs, scurvy, OK? Oh, maybe I need to know a little bit about transmissible gastroenteritis and vomiting piglets."  OK, so the ones that give you trouble, look them up. You don't have to spend a lot of time on it, maybe spend 15 minutes at the most question and just come in and make a note to yourself. That's a topic I need to tune up on. OK, extremely functional. OK, this is going to orient you no matter how you do it. To the straight from the horse's mouth. NAVLE® question style in depth. So these are highly recommended.


OK, here's another big mistake that people make before a test. They don't rereview their notes and books on the key topics. They say, I don't have enough time. I've already looked at stuff. I'm not going to look at it again. That's not the way to play the game, though, re-review. Is vital to reinforce stuff you've been studying for a while. I mean, who among us does not need a little tune up on? Testing for Cushing's disease. Anybody here not need that exactly. Somebody raises their hand. Nobody likes that guy anyway. We all need to tune up on basic testing for Cushing's and interpretation, things like that, just because it's endocrine. It's subtle. It's complicated. That's what you're rereviewdoes for you is go back and just give yourself a little tune-up.


You heard me mention that there's things you can do outside of study that help. And it's it's not rocket science. I'm sure many of you have either heard this or thought of it yourself. No. One get moving. Exercise studies of adult learning and coping have shown very clearly that people who exercise feel better and we cope better with stress. And senior year veterinary school is nothing, nothing if not stressful. So whatever it is, walk, run back. And we still could go swimming, which used to be my sport. Take your dog for a walk your hamster, go walk your wombat, do some aerobic square dancing, whatever it is, but move your body and give your brain a break. That's not the time to be listening to a podcast. Go just take a break and exercise. Things like that will help you do better when you come back to the computer to sleep perchance to dream.


When in doubt, choose sleep, sleeping helps your brain process the stuff you studied today. OK, and there are any number of studies out there that show that what's happening when you get that deep sleep and believe me, I've been to that school and I know it's stressful. Sometimes you're on midnight rotations, but do the best you can, but if you have the choice of whether to go to bed a little early or step three or four more hours and cram something in your head in the test is like weeks away. Go to sleep, OK? When they've done brain studies of this, what it appears to be happening, when you get that deep sleep below REM sleep below, like deeper than dreaming sleep. So your brain is pruning out extraneous information and suggests that this is one of the ways that the brain retains things better when you've had a reasonable night sleep.


A note on cramming to cram or not to cram. That is the question. Lots of studies show. If you're preparing for a test that's weeks or months out cramming, is it going to make any kind of meaningful difference? Yes, there are some studies that show if the test is tomorrow morning on a real specific topic and you've got to memorize a long list of things, you can make a short term difference and cram some stuff in your brain for that list. So if you got like a parasitology test tomorrow morning and you've got to learn twenty seven worms, OK, you might make a difference there. But when you're taking the NAVLE®, which is a test on everything in the universe of veterinary medicine. Go to bed, staying up late to cram is not going to make a difference for that. Get a good night's sleep, take the test fresh, and when you hit the inevitable questions that you don't know the answer to, which we all do. Yes, strategically, which we'll be covering in a different talk.


And finally, do take breaks, any number of studies of adult learning show that. If we don't take breaks, if we only focus, if we only are like working all the time, we decompensate, we overwork and then we don't retain information as well. And so taking a break could just be as simple as going to do that exercise. So two birds with one stone, you're taking a break and you're exercising. Just don't stick ear buds in your ears and listen to one of my talks or any other talk about veterinary medicine. Listen to music or the birds singing, OK.


If you're interested in how we learn and how we pay attention, I want to point you to a lesson from the course Learning How to Learn by Philip Oakley and Barbara Oakley. As I understand it, these are two of the most popular features on Coursera. And she has a really interesting and entertaining talk about modes of learning and basically is talking about how we think of focused. learning is what most of us think of what we learn. Like I'm going to focus, but look at the screen, take notes, and it's like A goes to B goes to C goes to the knee. Bone's connected to the femur, bone, femur, bones connected to the pelvic bone, pelvic bone articulates with the pelvis. Everything's very linear, very focused.


Diffuse thinking, though, is another way of thinking, another way of making connections, which is completely different. How many of you have had this experience? For me, it was like I would be swimming and I'm just in the pool. I'm in my rhythm. People get this jogging as well. You sort of like get out of your head and your body. You're not really thinking about anything. And suddenly you make this connection like, oh, yeah, yeah, the acetabulum has this little ligament in it. And then that helps this happen. And when you have a dislocation, something else happens. It's diffuse thinking, it's making random-ish connections, that doesn't happen when you focus, and that's valuable. So if you need even more of an excuse for why to take breaks. It's because you can exercise doing it, and it's because sometimes you can make interesting connections between stuff you've been chewing on and your subconscious doesn't just hadn't made the connection. Now, until you loosen up a little bit. OK.


Here's a final thing to introduce one of the next topics I'm going to talk about, and that's strengthening your working memory with images in cases. When we talk about working memory we're talking about the kind of memory where things are pretty accessible in my head. Somebody asked me a question and I look up and I go, oh, yeah, that's that thing, for example. So the point is you can use pictures to help you do that. Almost all of us remember better when we see the picture and clinical medicine lends itself to taking pictures of cases. So let's have a look at this cow. This is a thermographic. So where things are hot, it's red. And when things are cold, it's blue. So the floor he's standing on is blue. But look at that. His feet are red hot. His nose is kind of red, too. Hmm, what disease can I think of where the feet and the mouth and nose are somehow connected in the disease? Oh, yeah, foot and mouth. OK, so that becomes the picture you might stick in your notes for foot and mouth FMD, OK, which is a super useful, reportable disease you want to know about. And we'll talk about that in another class as well.


Over here, this could have come from a dog and let's say it's a middle aged Labrador retriever or maybe it's a boxer dog and had one little lump like the size of the end of your little finger. With the owners just checking them over, they notice it wasn't there before, and so you pop a needle in it, do a little cytology, a little aspirate, and you do a quick stain on this or right stain or something like that. And whoa, here's all these cells for the granules. Hmm. What could that be, what am I looking at, what are these cells in this little lump of a boxer or a middle aged Labrador retriever or something like that? And they're covered with these little granules? What's in this granules? What are we worried about here? We're worried about a mast cell tumor, aren't we? So what do we not want to do? We don't want to piss that tumor off and have it degranulate and have all that all those little histamine granules causing all sorts of immune reactions in the dog. OK, serious thing to know about, and that is mast cell tumors.


Here's just another one. This is these are two different eyes taken from pathology or two different chickens. This I here is normal to over here on my right on the left side of the screen. That's the abnormal eye.  What is a chicken disease? That's one of the big ones. You don't need a lot of chickens for Natalie, but you probably need to know four or five just to get through. This is one of the big ones. And what we're seeing here is a, it's like a white cell infiltration of tissue in this case, we've got an infiltration that's distorting. Pardon me, the iris. OK, you might instead also see a pathology necropsy specimen of a chicken opened up and you look at the sciatic nerve and on one side, the sciatic nerve is all swollen. Similar idea. It's an infiltration. Right, we're thinking about Marek's disease, right? OK, so there is a nice picture to stick in your Marek's disease notes.


You've got one more. OK, so this is it's nasty to look at, but this is a relatively common thing. You'll see maybe in barn cats is where I've seen it. Cats spend any time at all around cattle. Sometimes you can see this in cats that have been around rabbit burrows, different organisms, if I recall. But it's the same same issue. But anyway, we're looking at this thing. What do you think we're looking at? Is that a tumor? No, that's not a tumor. That's clearly an organism. And so we've got a great big old subcutaneous bot tuberiba larva in there. And what we're looking at here is the breathing end of it.


OK. And on the boards, here's just a preview. They may not ask you, what is it you'll say? Well, it's a subcutaneous parasite larva. They might say, what are you going to do to get what you're not going to do is try to pop that thing. You want to get it out. You don't want to rupture it and then cause a whole bunch of subcutaneous infection. OK, so probably you're going to want to anesthetize the cat. You may have to widen the aperture of the opening somewhat when you see these normally in animals that holes not usually that big and you want to gently pop it out of there and then, of course, clean it out.


And that is a quick summary of things you can do to turbocharge and get the most out of the final month before your board. OK, there's other things you can do to help information stick a little better, which we'll talk about in the next segment. And we'll also talk about just practicing being more strategic test taker, both on simpler questions, we don't know the answer, but also on some more these higher level NAVLE® format questions, and that'll be our topic for the rest of the day. Thank you very much, everybody.