AbalaTIPS 101: Philippine Medical Exam Test Taking Strategies: Art and Skills of

Good day everyone mga dok, welcome ulit sa AbalaTIPS: 

Well based sa feedbacks of some of friends and followers why don't I create a blog for test taking strategies meaning during the exam as per feedback, but this will lead me into 2 disclaimers, take note of this

Disclaimers:

1. This AbalaTIP is not designed to substitute review or base your answer on testmanship skills alone, TAKE NOTE: THE BEST TESTMANSHIP SKILLS is RECALL AND CORRELATE WHAT YOU HAVE LEARNED DURING YOUR REVIEW OR STUDYING THAT's WHY I CREATED ACTIVE LEARNING BLOG.

2. This AbalaTip is not intended to invalidate or to mention that your learning method is wrong, but rather this is a guide and to emphasize the advantages of active learning in medical school

Scope and Limitation:

This blog will be limited to multiple test taking questions which is one of the most common test methods used in the test, this will not include the practical test in laboratories.

Pre-test game plan

1. Always check the questionnaire given to you, aside from checking the completeness of the questionnaire you will have an idea of what you will write in the exam

2. Always check the Set, the Set is very important in terms of scoring in your exam

3, Do not put the scantron or answer sheet below the questionnaire while writing on the questionnaire since a simple mark on exam sheet from writing the questionnaire can put a mark and may be misread by the machine  

Testmanship Skills 101:

Introduction:

 In multiple choice, you will be given a set of questions and or answer there are types of multiple type questions enumerated here

1. Recalls

2. Statements

3. Percentages or numbers

 

Lets discuss the tips one by one

RECALLS- in this type of question, you will recall of what you have learned during your 5 years in medical school, I will divide this into two subtypes

A. Direct to the Point

B. Case-presented questions 

A. Direct to the point

1. Simple- straight to the point recalls in which you will be given a question, then you will answer it.

Example,

 Which is the most common type of Nephrotic syndrome in children

A. Idiopathic Nephrotic Syndrome

B. Transient Proteinuria

C. Alport Syndrome 

D. Minimal Change Disease

in this type of questioning is you supply the answer to the examiner, this will involve your recall of everything that you had learned in your Pathology or Pediatrics subject, which led you to answer letter B

 Take note: this is where you will be ask, make sure you know what is asked of you, do not overthink make it simple, since overthinking will lead you to wrong answer. just see what is instructed of you

2. Complex- you will be given a question then a set of two answers may seem to be correct

Example: Which of the following is NOT part of the management for children with Osteogenesis Imperfecta

A. Active nonphysical rehabilitation in children in early years

B. Splinting of fractures

C. Bisphosphonates

D. A and C 

E. None of the Above

Take note: 

* pls do not hurry, always READ READ READ READ of the modifiers in the question, take note of EXCEPT, NOT, NOT INCLUDED etc.....................pls encircle if you had saw this negative questions since hurrying may lead you into the trap so read read read the question carefully 

* if you have doubt or not sure what to answer, you can use the all or none of the above choice since it can give you 50% on arriving at a correct answer to the question, in the case of the question above the correct answer is E. None of the above

B. Case presented question, you will be given a case study question and you will answer it, base on the case presented to you by the examiner

Tips

1. A case may help you in going to the diagnosis or cases

2. To save time read the end question first before the stem case questions, sometimes cases are distractors and can waste your time, if it seems that end question is asking about the case, then that's when you will read the case

3. It is better also to practice bisecting these questions because this is where a two way or three way questions will be asked, ok I will demonstrate it 

Example:

 A 45/M call center agent comes in to your clinic with tingling and numbness of the left which started 1 week ago, during further taking of the history of the patient it is revealed that when patient feels uncomfortable he usually put his hand under his buttocks and when he sleeps in the office during night shifts, he uses his hands as his own pillow. What is the most commonly affected nerve by Carpal tunnel syndrome?

 A. Radial Nerve

 B. Ulnar Nerve

 C. Median Nerve

 D. Musculoskeletal nerve

Ok here in this case take a look first at the last statement, what is the most commonly affected nerve by carpal tunnel syndrome --> meaning the case in this type of question can be ignored to avoid wasting your time, since the question is just asking the type of nerve that is asked in the Carpal Tunnel Syndrome, but if..................

A 45/M call center agent comes in to your clinic with tingling and numbness of the left which started 1 week ago, during further taking of the history of the patient it is revealed that when patient feels uncomfortable he usually put his hand under his buttocks and when he sleeps in the office during night shifts, he uses his hands as his own pillow. What is the most common affected nerve on the patient? (Same Choices as above)

Here as you can see, this is now where the case will be relevant to the question that you need to read, this is also a two step question in which you need to answer the question

1. What is the disease involved

2. What is the most common affected nerve on the patient?

Now I know its a carpal tunnel syndrome based on my learnings in anatomy, the next question is the most common affected nerve, now i know its CTS so its is Median nerve

**Take note also sometimes the case will also give you a clue even the disease is there, it will save you time in terms of looking for more clues that will support your evidence in the case

But beware, most commonly asked in the exam is these "Cascading questions" meaning in one case many questions can be asked in many items from one case, one mistake on cascading question especially on diagnosis can lead into a domino effect on the next times 

Ex. An 11 y/o child comes in with a chief complaint of rashes, at 1 month prior to consult, patient experienced undocumented fever, not associated with cough, or cold, patent was taking Paracetamol and afforded temporary relief, however the child claimed that his neck has "masses" that was enlarged, painful, 3 days PTC, patient now notices rashes all over his body but more prominent on both cheeks, with pain on both knees, and he becomes irritable agitated, patient rushed to hospital and laboratories was done urinalysis shows incrrease in RBC while CBC shows low platelet. Patient was admitted to the hospital

1. What will be your diagnosis to this patient

A. Ankylosing Spondylitis                                          C. Scleroderma

B. Systemic Lupus                                                    D. Behcet disease

2. Based on your diagnosis, how will you confirm the diagnosis of that patient.

A. Increased Rheumatoid Factor                             C. anti-SSc

B, ANA antibodies                                                    D. Use schirmer test

3. What type of Immune reaction does the case above belong

A. Type I                                                   C. Type III                              E. AOTA

B. Type II                                                  D. II and III

This is what is called a cascading question, if you will be given this, your stem answer will determine the next step of your answer take a look at no. 1 and 2 in the case, be careful with this since it is a trap that your answer will have a corresponding answer on the next 2 statement, the moral of the story is that the very best test taking skills is to REVIEW WHAT YOU HAVE LEARNED in med school and STUDY HARD, use ACTIVE LEARNING for better retention of knowledge

Now i dont know the answer then do an educated guess meaning which of the following diagnosis above is the nearest to the case, the best way for me is do not look for the right answer, but look at the WRONG ANSWER, since if you already know that the answer is wrong then you can cross it out and increase the chance of arriving at the correct answer, just like doing a differential diagnosis in your SGD rule in, rule out

If you are not so sure with your diagnosis, you cannot really really remember, last resort is to separate your answer from previous, it could give you a chance of at least a correct answer instead of guessing a series which all are wrong answers

STATEMENTS- you will be given a state of statements and you will determine which of the following statements is correct, this is a true or false questions

Take note of the following

in the choices, usually extreme words like, NONE, EXCEPT, ALL, ALWAYS, NEVER, EVER are usually wrong

in the choices, usually more humble words like MOST PROBABLY, PROBABLY, ALMOST, MOST LIKELY, COMMONLY, are usually correct

ex. Which of the following is true for patients with COPD

A. Supplemental Oxygen is the commonly used Pharmacologic therapy 

B. Oral Glucocorticoids will be beneficial to all COPD patients

C. Clubbing of the digits is always a sign of COPD

D. Persons inside their homes and not smoking will never develop COPD

there is this 4 statements that look all that are correct but the question is very specific what is true for COPD patients, now applying the testmanship skills let us look for the wrong answer 1st

A. Supplemental oxygen is commonly used pharmacologic therapy, according to studies it unequivocally decrease mortality in patients (HPIM 21st p. 2188)- so probably correct but lets rule out other first 

B. Oral Glucocorticolids will be beneficial to all patients, it is not recommended since it has significant side effects - so this is already wrong

C. clubbing of the digits is always a sign of COPD, yes clubbing may be one of the signs of decreased air into the lungs but it is not a sign of COPD, but possible a sign of cancer arising from COPD- so again wrong

D. Persons in their homes and not smokers will never develop COPD, COPD can also arise from homes such as fumes from the kitchen or smokes of cars going inside the house, so wrong again correct answer is A

**Again but there is no substitute to studying harder

Next is One Step Stem Questions, meaning there will be two almost opposite answers, and most probably one of them is the correct answer

Example, 

Which of the following statement is not uncommon about left ischemic stroke on the middle brain

A. The affected part will be contralateral to the side of the body

B. The affected part will be ipsilateral to the side of the body

C. The affected part will be contralateral face

D. The affected part will be all 4 extremities

the best way to do this is to make them a T and F statement, again be very careful double negative questions, in which example not uncommon, meaning were looking for common, make it into a one positive statement and strikethruogh the not uncommon to decrease the chance for you to be mislead

Look at the answers, it is obvious that C and D is wrong also based on the explanation above the 2 almost same but opposite, one of them is correct, if we apply what we learned in medical school, it is obvious that C and D is definitely wrong answers so rule them out, now we have a 50/50 chance of arriving at correct answer but we learned from anatomy that in the medulla of the midbrain, the corticospinal tract crosses the midline so B is wrong and A is the most common. again review is the best weapon this serves as supplement

so the end result

 T   A. The affected part will be contralateral to the side of the body

 F   B. The affected part will be ipsilateral to the side of the body

 F   C. The affected part will be contralateral face

 F   D. The affected part will be all 4 extremities

Another way is to determine that is true or false to each question again put T and F to each choices to cross out some items, again for emphasis 

in the choices, usually extreme words like, NONE, EXCEPT, ALL, ALWAYS, NEVER, EVER are usually wrong

in the choices, usually more humble words like MOST PROBABLY, PROBABLY, ALMOST, MOST LIKELY, COMMONLY, are usually correct

Type K Questions- this are the type of questions that has a series of statements and will check if for example you know and correct the statements

For Example:

The following includes the Element/s of Medical Malpractice

I. The Physician has duty to his patients

II. The Physician failed to perform his duty to his patients

III. Injury was done to the patient secondary to failure of performing his duty

A. I and II are correct                             C. I and III are correct

B. II and III are correct                           D. I, II, and III are correct

Ok look this is a series of questions that is whats to pertain to elements of medical malpractice, the best tip here is to convert them into and individual true or false statement

True or false of element/s of medical malpractice

___ The Physician has duty to his patients

___ The Physician failed to perform his duty to his patients

___ Injury was done to the patient secondary to failure of performing his duty

based on our review we can that True True True, now let us look into the choices that has true true and true, based on the choices its letter D so D is the correct answer looking back at the choices above

Overall tips for Statement questions

1. look for the negatives or modifiers, if there is a negative, encircle it, turn it into a positive statement first to make it easier for you

2. I will copy and paste this from a Multiple Taking Strategies from DeMontfort Strategies in UK 

Difficult Words

 Don’t choose an answer just because it is the only one with words you recognize. Test-writers don’t put ‘make believe’ words on the test. If you only recognize the words in one answer, make sure it is correct and really answers the question before you choose it. If you can eliminate it, then you increase your chances of getting the right answer even if you have to guess.

 Try dissecting difficult words. Notice prefixes and suffixes for clues.

 Notice words like may, can, will often, rarely, etc. Often an answer choice will be wrong because it doesn’t contain these words but has definitive words like ‘exactly’ and ‘always’ which leaves no room for exception.

 Be alert for “switchback words such as “but”, “although”, nevertheless” which indicate a shift in thought and alters the nature of the question.

Phrases

 Be aware of answers that repeat word for word a portion of the question. It’s usually a wrong answer. Most correct choices paraphrase a point.

 Scientific sounding choices are better than ones using slang language.

Look for Clue Words and Numbers

 If two answers are opposite, one is probably correct.

 Answers with the following words are usually incorrect: always, never, all, must

 Answers with the following words are usually correct: seldom, generally, tend to, probably, usually

 Look for grammatical clues between the question and the choices. For example, the question and the correct answer often have verbs of the same tense and have nouns and verbs that agree.

 Underline familiar words or phrases from the lecture or textbook.

 Be aware of degrees of correctness. With numbers one choice is usually too small or too large. These choices may be eliminated.

Taken from (https://www.dmu.edu/wp-content/uploads/MULTIPLE-CHOICE-TEST-TAKING-STRATEGIES.pdf)

PERCENTAGES- the examiner will give you a question of a percentage or a number, however the usual rule here is that EXTREMES such as Smallest and Largest in the choices are usually WRONG answers

Example:

What is the risk of having an ectopic pregnancy in usage of Intrauterine Uterine Devices

A. 10-20%

B. 30-50%

C. 60-80%

D. 70-90%

Based on the statement above usually examiners put the extreme numbers usually as wrong answers so in the exam the A and D in the choices we can rule it out so we have 50/50 between B and C as a recall type o question we can do nothing but in the review memorize these percentages, the correct answer is B above