Study Smarter TM

Effective Study Strategies for the ECFVG

Basic Clinical Sciences Exam (BCSE)

Steven I McLaughlin DVM, MPH, DACVPM

Steve@Zukureview.com
www.Zukureview.com
1 800 928 8218
“It is not enough to be a good chess player,

you must also play well.”

-Savielly Tartakower
 A Story
Once upon a time, there was a world called veterinary medicine,
covered in many forests.

One forest was called “Pharmacology”; another “Physiology” and

so on.

In the Pharmacology forest, there were many trees. One tree

was called “Antibiotics” and another called “Antiparasitics”.

On that antibiotics tree was a single leaf called “Rifampin”

One day, a good-hearted but near-sighted

vet student wandered into the pharmacology
forest, and got so engrossed studying a leaf
on a single tree that she got lost, and a big
bad wolf called BCSE came and ate her.
The End
 The need for speed

It is time to go fast, people.

• The goal is not to know everything

• The goal is not to get every question right
• The goal is to pass

In the forests of knowledge, let this be your map

 This presentation

• BCSE Structure

• Study strategies for BCSE

• Test-taking strategies BCSE

 BCSE Structure
• 225 Multiple choice questions

• One continuous 225-question block

– 220 minutes (almost 4 hours!)
– ~1 minute per question
– “Many with graphics”

• 25 questions are “pre-test” items

– Not scored
– Cannot tell which questions are “pretest”
– Presumably being evaluated for use in future BCSE exams

• No breaks once you start

Source: http://www.avma.org/education/ecfvg/bcse_bulletin.asp#intro
 BCSE Pass Rates

?
To date, the ECFVG has released no data
on the numbers of people taking BCSE or the
numbers passing

Source: http://www.avma.org/education/ecfvg/bcse_bulletin.asp#intro
 BCSE Topics: Not exactly “laser focused”
1) Anatomy 18-22 Qs (~9%)
2) Physiology, Pharm., Tox. 24-28 Qs (~12%)
3) Pathology 22-26 Qs (~11%)
4) Medicine 42-50 Qs (~20%)
5) Surgery and anesthesia 34-38 Qs (~16%)
6) Diagnostics 26-30 Qs (~12%)
7) Preventive medicine 18-22 Qs (~9%)

BCSE is like a “mini-NAVLE”

“….designed to assess basic and clinical veterinary sciences knowledge.
The knowledge level expected ……of an entry-level US veterinarian (ie, new
graduate of an AVMA-accredited veterinary school) .”
Source: BCSE Candidate Bulletin http://www.avma.org/education/ecfvg/bcse_bulletin.asp#outline
 Worth Remembering on Test Day
• Must show up 30 minutes early
– Must have Authorization to Test (ATT) letter w/ unique i.d. number
– Must have TWO forms of identification
• Photo-i.d. with signature, and name (ie: driver’s license, passport)
• Secondary i.d. with signature
– Name on BOTH i.d.s must match ATT name

• No personal belongings allowed in test room

– No calculator, cell phone or digital watch
– No food or drink
– No backpack, brimmed hats, purse or coat

• What is allowed ?
– Erasable whiteboard provided for calculations
– Some people bring earplugs

Source: http://www.avma.org/education/ecfvg/bcse_bulletin_pf.asp#identification
Why bother to study effectively ?
• BCSE is foundational knowledge
– Concepts support your NAVLE prep
– AND help you in clinics

• Use motivation of BCSE to learn how to learn

(This isn’t the last test you’ll ever take….)

• Who wants to waste time and money taking this

test more than once?
 Example of a BCSE-style question

Which stage of the canine estrous cycle is

characterized by > 90% cornified epithelial
cells with pyknotic nuclei and a lack of neutrophils in
a vaginal smear? Remember: "CORNflakes go with MILK."
Think > 90% CORNified, superficial cells in canine
estrus (angular, sharp edges like corn flakes, tiny
(A) Late diestrus pyknotic nuclei or no nuclei, no neutrophils).
Full cornification usually coincides with receptivity.
(B) Late estrus
(C) Early diestrus Follow this link to see a vaginal smear from a dog in
estrus
(D) Early proestrus http://www.merckvetmanual.com/mvm/htm/bc/mgnrs905.htm
(E) Anestrus and in diestrus
http://www.merckvetmanual.com/mvm/htm/bc/mgnrs903.htm

Source: Merck Vet Manual http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/181903.htm

 Example of a NAVLE-style question
You are assisting a dog breeder decide when to breed
her prize Siberian mousehound.

A vaginal smear looks like this:

http://www.merckvetmanual.com/mvm/htm/bc/z-mgnrs905.htm

What would you recommend to the owner ?

(A) Cannot say from this slide

(B) Cannot say with only one smear
(C) Breed the dog today
(D) We missed her estrus, wait 2 months
(E) Not in heat yet

Source: The Zuku Review, online veterinary test prep

http://zukureview.com/index.php and the Merck Manual online
 If the BCSE is so broad,
where do I start?
Be guided by BCSE example questions
http://www.avma.org/education/ecfvg/bcse_practice_test.asp

– A springboard to study

– A pointer to key topics

– Gives you a sense of the depth, style of questions

Note: BCSE questions are similar to the QE.

For more practice, try the PAVE QE practice test .
http://www.nbvme.org/?id=35&page=QE+Sample+Questions
 Where to start? An example
Which of the following changes occurs as
a result of metabolic acidosis?

(A) Oxygen-hemoglobin saturation curve shifts to the left

(B) Plasma becomes hypotonic
(C) Plasma ionized calcium concentration increases
(D) Serum glucose concentration increases
(E) Serum potassium concentrations decreases
Suggests “physiology & acid base” worth a review

Source: Example from PAVE QE practice test, similar to the BCSE http://www.nbvme.org/?
id=35&page=QE+Sample+Questions
 Where to start? Another example
Which of the following is the most likely finding
on a leukogram from a cow with a large
chronic abscess?

(A) Monocytosis with left shift and toxic change

(B) Neutropenia and eosinopenia
(C) Neutropenia and monocytosis
(D) Neutropenia with left shift and toxic change
(E) Neutrophilia and monocytosis
Suggests “Clin Path / white cell function” worth a review
Source: Example from PAVE QE practice test, similar to the BCSE http://www.nbvme.org/?
id=35&page=QE+Sample+Questions
 Study Smarter TM

“Successful learning is not measured by how

many hours you study.

Successful learning means using the hours

you do have effectively.”

-Dr. Zuku
(Steven I Mclaughlin DVM, MPH, DACVPM)
 A study technique that
doesn’t work
“I spent 6 hours reading endocrinology
on Saturday,…..

But Monday, I didn’t remember any of it !”

“Reading = Learning”
 USE IT OR LOSE IT
• MOST adults forget 50% of what they just read

• And 80% within 24 hours

BUT !!

• Anything you have studied well will come back

very quickly with a review

….if you make good notes

Another study technique that
doesn’t work

Treating every single factoid as if it

were important
Ref: Dyce, Sack and Wensing Textbook of Veterinary Anatomy

No “take home message” here!

Learn to recognize the most important 3 points
 Study Smarter TM

• Start with a calendar

– Map out your study plan, week by week
– Make test prep part of your routine

• First Pass: finish 3 weeks before test

– All study-mode tests
– Write out summary notes

• Second Pass: during the 3 weeks before test

– All test-mode tests
– Review summary notes
 Study strategies for BCSE
The 50:50 rule

Study ~50% Practice testing ~50%

-Map out the topic
-Hit the books
-Write summary notes
-ROUTINE
-REVIEW those NOTES a couple times a week

Goal: Finish study-mode tests, complete summary

notes 3 weeks before the test
 BCSE Study Plan:
First Pass
Monday:
Tests: ClinAnat #1,DxImaging #1,Pharm #1,Surg#1, Physio #1 etc.  Note mistakes. ~1 hr
Study: Quick read of 5 key disease topics ~ 1 hour

Tuesday:
Tests: Do My Missed Questions from yesterday to reinforce
Start new tests- ClinAnat #2,DxImaging #2,Pharm #2,Surg#2, Physio #2 etc.

Study: Write summary notes on the 5 topics ~ 2 hours

Wednesday:
Tests: Do My Missed Questions from yesterday to reinforce
Start new tests-ClinAnat #3,DxImaging #3,Pharm #3,Surg#3, Physio #3 etc.

Study: Quick review of summary notes from Tuesday

Quick read of 5 new disease topics ~ 1 hour
…………..etc
Summary notes: 50% of your time
• Why write summary notes?
– Translates info into language your brain understands
– Customized notes worth weight in gold in weeks before test

• Map out the topic

– DON’T reinvent the wheel
– Use textbook table of contents or class syllabus

• The rule of 5- never more then 5 ideas per topic

• Add “Mental Velcro”

– Images
– Disease examples
 Mental velcro: Images
A picture IS worth a thousand words:
Add pictures to your notes

Fluid-filled lungs: Pulmonary edema

“Floating lungs”: Pleural effusion

Images courtesy of Dr. Terri Defrancesco, DVM, ACVIM,

All rights reserved, copyright 2007-2010
 Mental velcro: Disease
Horner’s Syndrome:
Remember "My 3rd Sunken Toe“

(Miosis, 3rd lid protrudes, Sunken

eye, Ptosis) and "sweaty horses".

A syndrome, not a disease per se.

See 4 things with Horner's, ALL

associated with the eye:
1. MIOSIS (constricted pupil-lose
sympathetic innervation)
2. PROTRUSION 3rd eyelid
(nictitans)
3. ENOPTHALMOS (sunken eye)
4. PTOSIS (drooped eyelid), +/-
anisocoria
What is it?
http://commons.wikimedia.org/wiki/File:Horner
Image courtesy, %27s_syndrome_dog.JPG
Dr. Joel Mills, Wikimedia Commons
 Map Out Your Topic
You are on the ground
in the forest of “Pharmacology”,
looking at a tree called “Misc antibiotics”
and a leaf called “Rifampin”.

To figure out where you are

(and to get where you want to go),

Visualize where you are from 10,000 feet up

 Map example: Pharmacology
Map from 10,000 feet Map from 1000 feet

5 “Antis” I. Antibacterials
A. ‘cidals
Antibacterials B. ‘statics
Antifungals C. Misc antibiotics
Antiparasitics
Antivirals Map from 100 feet
Antineoplastics C. Misc antibiotics
1. Chloramphenicol
5 “keys” 2. Rifampin
3. Metronidazole
Key Cardio drugs
Key Optho drugs
Key Repro drugs Map on the ground You are here
Key Endo drugs 2. Rifampin
Key Renal drugs a. Gen info
b. Primary use
Misc c. Contraindications
Key antidotes/tox reversal agents d. Cautions
e. “mental velcro” (Image, disease)
Analgesics
Tranquilizers
 Summary notes part 1: Pharmacology, Rifampin

2. Rifampin
a.General-‘cidal or ‘static dep. on microbe

b.Primary use -Rx Rhodococcus equi, young horses

c.Contraindication -Beware in hypersens animals, hepatic dysfxn

d.Caution
1). May cz red-orange urine, tears, sweat
2). Don’t use alone or see rapid resistance
3). Give on empty stomach

e.Mental velcro- Rhodococcus equi

References: Plumb’s Vet Drug Formulary 5 th ed. pp.992-4,

Merck Vet Manual online, http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/191282.htm
 Summary notes part 2: Rifampin
Mental velcro (image and a disease)

References: Pasquini, Pasquini & Woods, Guide to Equine Clinics, 3 rd ed. p. 113
Notes developed by senior veterinary student for educational use preparation for NAVLE
Image courtesy, Angeline Warner, DVM, D. Sc: http://ocw.tufts.edu/Content/27/imagegallery/367446/367480
 Where to get a fast disease summary

From: Pasquini, Pasquini & Woods, Guide to Equine Clinics, 3 rd ed. p. 113
 Outside a dog, a book is a man’s best friend.

Inside a dog, it’s too dark to read. - Groucho Marx

If you believe everything you read, better not read.

- Japanese proverb
 Practice testing for BCSE:
50% of your time

“You don't get ready for a marathon by

reading a book about it.

You put on your running shoes and run.”

-Dr. Zuku
 Recommended books for BCSE
For medicine and disease summaries:
Bovine: *Guide to Bovine Clinics 4th edition—Chris & Susan Pasquini
Equine: *Guide to Equine Clinics 3rd edition—Chris & Susan Pasquini, Phil Woods

Dogs and Cats:

*Veterinary Clinical Advisor, Dogs and Cats, 1st ed. Cote' ed.
*Tschauner's Guide to Small Animal Clinics 2nd ed.—Chris & Susan Pasquini
Blackwell's 5 Minute Veterinary Consult, Canine-Feline 4th ed. Tilley & Smith eds.

Clinical Anatomy: Anatomy of Domestic Animals 10th edition— Pasquini, Spurgeon and Pasquini
– On almost every page you find a box that tells the clinical significance, diseases associated
with that part. Superb. Study those. Make short notes. Go fast.

Pharmacology: *Plumb’s Veterinary Drug Handbook, 5th edition, Donald C. Plumb

– The original and a favorite, available as a book or online through VIN

Physiology: Veterinary Physiology, 4th ed. Cunningham and Klein

– Good case-based organization, FAR easier to navigate than Duke’s

Clinical Pathology: Duncan and Prasse's Clinical Pathology, 4th ed.

– 35 excellent case studies in appendix. We like this one, but other texts are also good.

Anesthesia, dentistry, basic surgery: Clinical Textbook for Vet Techs, 7th ed, McCurnin & Bassert
– Great images, good tune up on basics.
*Zuku Review Pick of the Litter
TM
 Multiple choice tricks of the trade
• The Good News
Correct answer is GUARANTEED to be among the choices

• The Bad News

You WILL hit questions you don’t know

Common mistake: Spending MOST of your time on

questions about which you know the LEAST.

• Key to success:
Train yourself to MAKE CHOICES and then MOVE ON.
Sources of practice questions
• BCSE sample test
http://www.avma.org/education/ecfvg/bcse_practice_test.asp
• QE sample test (similar to BCSE)
http://www.nbvme.org/?id=35&page=QE+Sample+Questions

• Vet Board Games cards http://www.veterinaryboardgames.com/

• Zuku Review BCSE course, Question Archive

http://zukureview.com/QOD_Archive.PHP

• CAPC parasitology test http://www.capcvet.org/other/resources.html

• Mosby’s Basic and Clin sciences questions

 Multiple choice tricks of the trade
• READ the question first (DON’T look at answers)

• PREDICT the answer (protects you from distractors)

• Is your answer the best of the choices ?

If “Yes” SELECT it and move on

• Unsure of the correct answer ?

ELIMINATE wrong ones, choose from what’s left,
and MOVE ON
“What if I don’t think this system will work for me ?”

Do what works for you.

“How do I know when I should I change an answer ?”

Stick with your first answer unless you recognize that it

is clearly not correct - studies show that changed answers
are more frequently wrong.

“I am clueless about chickens/cardiology/box turtle

halitosis, what do I do?”

Read, Predict, Eliminate, Select -The correct answer is

guaranteed to be among the choices. Whittle the
choices down to as few as possible and guess.
 The 24-hour “golden period”
period of
short-term memory
• A mistake is the best teacher
– Mistakes sting
– Sting helps you remember,
…...IF you redo missed question within 24 hrs

• After 24 hours, most new info fades from memory

• Note questions you miss today on scratch paper

• Redo “Missed Questions” tomorrow

– Reinforces weak areas fast
 Pop Quiz

What is a Cook's speculum?

A)   Three-pronged ear speculum           

B)   Four-pronged rectal speculum
C)   Three-pronged nasal speculum       
D)   Three-pronged rectal speculum
 Multiple choice tricks of the trade:
Convergence
What is a Cook's speculum?

A)   Three-pronged ear speculum           

B)   Four-pronged rectal speculum
C)   Three-pronged nasal speculum       
D)   Three-pronged rectal speculum
This is an example of convergence. 

Options A, C and D all contain the words "three-pronged“

Options B and D both contain the word "rectal."

These two sets converge at option D

Adapted from: Leo M. Harvill, Ph.D. “The Test Of Obscure Medical Information”
 Multiple choice tricks of the trade:
Prognosis
Questions about prognosis tend to be all or nothing
(ie: clearly GREAT or clearly HORRIBLE)

Prognosis/success rates by percentage:

Excellent 90-100% (ave: 95%)

Good 65-89% (ave: 75%)
Guarded/Fair 35-64% (ave: 50%)
Poor 11-34% (ave: 25%)
Grave 1-10% (ave: 5%)

Ref: Pasquini's, Tschauner's Guide to Sm. An Clinics, vol 1, 2nd ed. p. 11

 Multiple choice tricks of the trade
Images
• CENTER
Most photographers put lesion centrally in photos

• Radiographs are an exception

– Must look over WHOLE x-ray
– History gives clues
• Hit by car? Check for pelvic or femoral fracture, dislocation,
Check for diaphragmatic hernia (bowel loop in chest)
• Straining to urinate? Check bladder for stones
• Regurgitation? Check for lung field for megaesophagus

• No normals- Good images are hard to get.

UNLIKELY to see picture with nothing wrong
 If there is a problem in this
picture, where is it ?
(click link)

http://www.merckvetmanual.com/mvm/htm/bc/z-exlha29.htm

Intussusception, Hamster, center of image

Click this version for explanatory text:

http://www.merckvetmanual.com/mvm/htm/bc/z-exlha29.htm

Reference: The Merck Veterinary Manual online edition

http://www.merckvetmanual.com/mvm/index.jsp
 Where is the problem?

Image courtesy,
Dr. Peter Schantz

Tongue ulcer, canine leishmaniasis

 Where is the problem?

Image courtesy,
Dr. Kim Stanz

What is it? Ulcer, possible descemetocoele

 Where is the problem?

Image courtesy,

Dr. Terri
Defrancesco

What is it? Endocardiosis, mitral valve

What, if anything, is wrong with this picture?

History
Hint:
This cat is
having
urinary
accidents

Image courtesy,
Bladder stones Dr. Scot Nachbar
 If anything is wrong with this picture,
in which quadrant is the problem?

History
Hint:
This beagle was
hit by a car

Image courtesy,
Upper left quadrant, Ilial fracture Dr. Scot Nachbar
 What, if anything, is wrong with this picture?

History
Hint:
This 6 month
old Labrador
regurgitates
soon after
eating

Megaesophagus: note ventral deviation Image courtesy,

of tracheal carina, dilation of esophagus Dr. Terri Defrancesco
 Online Case Study & Image Resources
Surgery case studies
http://www.acvs.org/AnimalOwners/HealthConditions/

Radiology case studies

http://www.vet.k-state.edu/depts/VMTH/radiology/cow/index.htm

Radiology artifacts
http://vet.osu.edu/index.php?id=2355
Tech hint:
Clin Path Case studies
Right-click
http://www.medvet.umontreal.ca/clinpath/choice.htm your mouse
over an
Clin Path images internet image,
http://www.medvet.umontreal.ca/clinpath/banq-im/menuE.htm to copy and
paste it
Pathology/Histopathology images http://w3.vet.cornell.edu/nst/nst.aspelsewhere

Vet video library: www.vetvideos.com

Merck images online http://www.merckvetmanual.com/mvm/index.jsp?

cfile=htm/bc/mvm_list_img.htm
 The final 3 weeks
Second Pass
“In the final weeks before a big race, you
change your training to mimic the race.

In the final weeks before test day,

change your study to mimic the real test”

-Dr. Zuku
 The final 3 weeks
Second Pass

Study Practice testing

-REVIEW your notes
-Skim misc topics not in notes
-Test yourself with flashcards,
friends, game cards
Do timed test-mode tests
-60-question tests build stamina
-Random topics
-No answers as you go
-Mimics the real thing

Goal: Finish all test-mode tests

Redo “Missed questions” within 24 hours
Review summary notes until solid in your mind
 The final 3 weeks
Keep a routine
• Get regular exercise
…Run, swim, square-dance, walk your dog, hamster or wombat

• Get up early every day,

….about same time you need to wake up on test day

• Start with a decent breakfast

• Go immediately into 2 hours of practice tests, then notes review

• Get your mind & body into a routine so the big day feels routine too

• Don't give up.

• On test day, walk in with your head held high,

and take it one question at a time
 Remember 4 things

1. ~50% study, ~50% practice testing

2. Redo “missed questions” w/in 24 hours

3. Try to finish first pass on summary notes &

study-mode tests 3 weeks before test

4. In final 3 weeks do test-mode tests, review notes

 If Time is Short
• ~1/3 time reviewing notes

• ~2/3 time taking tests

– Read, Predict, Select, or Eliminate

– Redo "My Missed Questions“ w/in 24 hours

– Pay attention to images in questions

– Finish all test-mode tests in final week

• Stay Positive
– Panic is not productive; don’t waste energy on it

– Test-takers with forward momentum and a positive attitude do

better on tests

– Do what you can, keep moving, and don't give up

 Good luck!

“No student knows his subject:

the most he knows is where and how to find out the

things he does not know.”

–Woodrow Wilson
 References
The summary of multiple choice strategies comes principally from:

“What Smart Students Know” by Adam Robinson, co-founder of The Princeton Review test
preparation company

George Washington University Academic Success Center- “

Strategies for Multiple Choice Questions”

Kaplan Test Prep US Medical Licensure Exam (USMLE) Strategy Sessions

Convergence concept Adapted from: “The Test Of Obscure Medical Information”

Leo M. Harvill, Ph.D.

ECFVG Candidate Bulletin http://www.avma.org/education/ecfvg/bcse_bulletin.asp

BCSE practice test http://www.avma.org/education/ecfvg/bcse_practice_test.asp

QE practice tests
Text version: http://www.nbvme.org/?id=35&page=QE+Sample+Questions
Web version: http://nbvmepractice.starttest.com/
Extra slides
 Another example of good notes

References: Cote’, Veterinary Clinical Advisor, Dogs and Cats, 1st ed, pp. 259-60 &
Pasquini& Pasquini, Tschauner’s Guide to Small Animal Clinics, 2 nd ed. p. 703
Notes developed by senior veterinary student for educational use preparation for NAVLE
Image source unreferenced. May be used only for educational purposes
 Another Example of Convergence

Budin's rule states that the amount of cow's milk

consumed per day for a bottle-fed baby should be
approximately               of the weight of the baby.

A)   1/10            
B)   1/8 
C)   1/7        
D)   2/10
 Multiple choice tricks of the trade:
Convergence
Budin's rule states that the amount of cow's milk consumed per day for a
bottle-fed baby should be approximately               of the weight of the baby.

A)   1/10            
B)   1/8 
C)   1/7        
D)   2/10

A, B and C are similar: they have “1” in the numerator;

A and D are similar: they have “10” in the denominator. 

A test-wise examinee will choose A because it appears in

both sets above.  The correct answer is A.
Adapted from: Leo M. Harvill, Ph.D. “The Test Of Obscure Medical Information”