Well, good morning, everyone. My name is Tony Decker, and we'll be doing a presentation on test-taking psychology and strategies. This is the part of the course for the board preparation for the CAQ in addiction medicine through the American Osteopathic Association. We'll have a chance to talk towards the end. I can't see the chats right now. Neal will stop me if there's an urgent question, and then we'll have a chance to go over things at the end. And I think we'll also talk a little bit about the actual test instructions that are coming out right now from the AOA and from Pearson. I'm a primary care physician. I went to Michigan State University, graduated in 1978 from the osteopathic program there, did my internship and residency in family medicine at Chicago College of Osteopathic Medicine. I did a fellowship at Press St. Luke's in adolescent and young adult medicine, and I've spent the vast majority of my career with the government. I did public health service on Chicago's South Side for 14 years, went to Kansas City as the chief of family medicine from 94 to 98, also was part of Job Corps during that time, and then went to the Indian Health Service in 1998, stayed until 2010. From 2010 to 2015, I was with the Department of Defense at the Fort Belvoir Community Hospital, which was a replacement hospital for Walter Reed Medical Center, Army Hospital, and then came to the VA for five years and just became part of the primary care service line at the Gallup Indian Medical Center. Everyone's had, unfortunately, all of us have experienced the COVID epidemic, but there's been especially a very heavy burden on the Navajo Reservation. I have no conflicts of interest to report. I have no relationships with pharmaceuticals, no prohibited donors. I am the past president, or one of the past presidents, of the American Osteopathic Academy of Addiction Medicine, which is a sponsor for this course. Although I've spent my entire career with the government, I do not represent any tribal or federal organization. For this educational program, the opinions I express are simply my own opinions. I should say that I've received a fair number of emails from previous presentations asking if I know certain things are going to be on the exam. The examination is run by the American Osteopathic Association through the credentialing program or the certifying program. People who are contributors to the exam are not allowed to teach the board exam program. I have no idea what's going to be on the exam. I personally will be taking the exam, along with many of you, and it looks like we're all going to be doing it virtually from our homes. The reality is I have the same knowledge or same information that you have in regard to the content, and that's that sheet that we sent out or that document we sent out that shows all the percentages of different topics that are categorized as important for the examination. That was based on surveys that were done across the country by the American Osteopathic Association, and it's actually one of the standardized criteria for board exams for not only the Osteopathic Association, but also the American Medical Association and their credentialing bodies. So our objectives for this course is to understand a few concepts. One is to understand working memory. The second thing is to understand and identify the prompt. There's a prompt in every question, and that's the most important part of the question. We want to prevent twisting data. That's something that many of us do is that we get a lot of information on a board question, and then we start to think, well, this is what they're asking. The easiest way to figure out what they're asking is look at the prompt, look at the answers in the foils, and then you identify the best answer. Our goal is to maximize your performance on this board examination, and so it's an important part of just realizing the rules of engagement for this type of exam. So when we look at board questions, we have questions that are submitted by identified experts. They are vetted to stress your working memory. They require unique reading skills. Think about the specific question being asked. Some questions are related to previous questions like a clinical case, and that's a little bit more complicated. We'll talk about those later on, but most questions are straightforward. They have a question. They have at least four or five foils, and out of those foils, they'll be listed in alphabetical order. You want to interface strategies that will prompt ineffective and inefficient processes, so you want to make sure that you don't get tangled up in the weeds because sometimes these questions are rather long, and it's hard to figure out what exactly are they asking, so we're going to talk about how to identify what is the actual question being done. Some stimuli can lead to twisting, and they can confuse your train of thought, and our goal here is to minimize that process, so identify the prompt, try to figure out what is the actual question being identified or being asked, and then we want to have the best way to interpret. Almost everybody can delete two foils, so if you have five answers, only one is correct, you most times can delete two of them. Sometimes you can delete three of them. If you can get it down to two, it's a choice between two of the best answers, then you're in a pretty good situation, so the goal is to get to that point. So our working memory is a part of our cognitive process, which we use to solve problems. Applying this to board questions may precipitate some confusion, though. As physicians, we're used to giving a set of problems and getting an answer. Many of us, before the patient is even done with their presentation, their history, we already have identified what the problem is and what the solution is. That's not the best way to practice medicine, by the way, because we want to get all the information possible, but the reality is we're trained to be efficient. When you consider a board exam, though, the board exam, you want to be efficient, too. You want to get all the questions addressed. You want to get all the answers put down in an efficient and effective, correct manner. So the board questions are designed to emphasize your working memory. You need to implement a process to interface questions and limit the working part of your working memory, and the reason for that is our working memory is probably going to be limited to 45 to 60 seconds. So we only have a certain amount of time to get the best product. So what are the challenges of working memory? Most individuals, 30 to 45 seconds is their highest function. Physicians and people of higher intellect tend to have 45 to 60 seconds, and there's actually an entire psychology of test-taking. Our working memory is like a notepad to work on a problem. So we're putting information in, we're visualizing that information, we're processing that information, and we make a decision. So when the notepad gets too cluttered, you have too much data, systems can become very confusing, and I think the goal here is to get ourselves to the point that we minimize our confusion. This especially happens when you have narrative-type questions, this 35-year-old female presents with, and then you're going to have all this data that's there. And multi-question series questions. So the next three questions pertain to this presentation, and you may have a stimuli, a picture, an X-ray, or a lab result, and then they're asking about this particular case. Working memory is very high function and very high metabolism. They actually have brain scans when people are doing this, and it shows how much activity is going on in the cerebral cortex. You need to be prepared for this challenge. So adequate sleep for at least the week before you take the exam, appropriate nutrition before you take the exam, and alertness will all be challenged. Some people think that if they study with only two or three hours sleep every night for the three nights before the exam, sort of cramming everything else in there, it gives them the highest performance, but that's not really the best way to look at a board exam. Because a board exam is going to be asking all kinds of questions, covering a lot of territory, and you want to be able to pull open those file drawers in your brain as needed. When you're challenged, the wrong answers may look right. I don't believe that they write these questions specifically to be trick questions, but they do write them in a way that challenges your ability to choose which is the best answer. Because sometimes the best answer is not listed. It's the best answer listed that becomes important. Do you want to prevent overload? When given a vignette, several pieces of data are rapidly processed. Some of the data sets are more important than others. The data is not weighted on the exam, so you have to distinguish and you have to prioritize what data is the most important. Which foils can be eliminated? Some questions make the participant feel like they're being tricked, and you may question yourself, creating a cycle of inability to identify the correct response. Learn to focus on what you feel are the important parts of the question. So let's take a question and let's break it down into pieces. This 45-year-old male police officer presents with blood pressure of 182 over 112. He has a fever. Temperature is elevated. They don't tell you the temperature, but he just says he has a fever. So by definition, we're going to assume that his temperature is above 100.4 or 101, depending on what you consider a fever. He is upset about his superiors. He denies alcohol use for the past 72 hours. What is your next step? Now, you need to identify the prompt. The prompt, which statement is most accurate regarding his presentation? The stem is the body of the text or the last sentence. So the vignette is the text, the images, the entire construct of the question. So the most important part of this question is what is the question asking? So it says, what is your next step? That's what it's asking. So you need to get labs, A, B, C, or D. A is need to get labs, CBC, to rule out infections, CMP for metabolic, lactic acid, blood alcohol, and UDS. Or cardiac workup with troponin, CKMV, EKG, chest X-ray. Or a CEWA score, IV hydration with thiamine 100 milligrams, folate 1 milligram, and MVI, multiple vitamins injection or infusion. Seizures are uncommon in this scenario. So we're going to go back and forth on this right now. So the prompt is usually the last statement. Next step. And it's critical to identify the prompt in every question that's being asked. Which statement is most accurate regarding his presentation? So what is your next step? The stem is the body of the text or the last sentence. So there's a lot of foils that are in there. So it says, he's upset about his superiors. He denies alcohol use for the past 72 hours. Anyone who works in the field of addiction medicine is assuming that, okay, this patient's headed towards alcohol withdrawal. He's hypertensive. He's febrile. He's agitated. He admits he's upset with his superiors. He hasn't drank alcohol for 72 hours. So he's right in the target zone for alcohol withdrawal syndrome. So what happens is you want to identify what is your next step. So getting labs, always a wonderful thing. But is that the most important thing? We know that when patients are febrile and when they're hypertensive, they're very close to having a rapid acceleration of alcohol withdrawal. So we need to get that patient staged with a CEWA score. We've got to hydrate them. We've got to give them thiamine. We've got to give them folate. And we've got to give them an MVI. Now, you notice that the other answer in here, which is this patient needs IV lorazepam or librium or valium, that's not an option here. So if I saw this patient in the emergency room, we do several things all at the same time. But one of the things is I'm going to give that patient a benzodiazepine or a phenobarb to knock them down on their alcohol withdrawal. But of the FOILs that I have here, it says, what is your next step? And inferred at the beginning of the exam, they tell you, choose the best answer available. So working a patient up for cardiac evaluation, patient doesn't really show chest pain, shortness of breath, diaphoresis. So we don't have that. I'll vote. I mean, if you read into it and you say, well, I've got to make sure he doesn't have a heart attack first, that's a FOIL. Seizures are uncommon in this scenario. Well, it's pretty clear that actually seizures are what we're trying to avoid. So D is out. So we can eliminate B and D right off the bat. So should we get labs before we treat the patient? Well, none of what we're treating the patient for will change those labs. So yes, we want to get labs, but we're not going to get those results back for 15 to 30 minutes. So providing the intervention immediately with what we know this patient is going to need becomes the most important way to look at this particular question. So always identify the prompt. Read it first. So it's interesting because it's typically the last statement or the last sentence or the question that's at the end of the question. So when I take an exam, I open up the thing, get myself all set, get myself centered, focused, and then I read the first question and I go right to what's the question. So to go backwards here, the question is, what is your next step? Then I read the rest of it, a 45-year-old male police officer presents with hypertension. He's hypertensive, he's febrile, he's agitated, he's upset with his boss, he denies alcohol for 72 hours. Okay, I'm sort of figuring out, okay, what's my next step? That's the most important part of this question. Now I'm going to go down to my options and I'm going to start reading down. I start at the top and just go right through. Now notice in this particular question, they're not in alphabetical order. On the examination, we're told, the AOA has told us that these will be in alphabetical order, but I haven't seen the exam, so we have to see what they're going to end up doing. Then read the passage, remembering the prompt. Then you read each option one time, comparing it to the prompt. Now, in the old days, when you had a paper-pencil test, we could take a piece of paper – or take our pencil and just scratch out the foils that didn't count. You can't really do that on the electronic test, so you have to kind of remember. You are allowed to have a notebook or a scratch pad next to your computer when you're taking the exam. So, you can write down – especially on those long questions, you can write down some of the things that are important. Don't write out the question. I typically write down B and D out. And then I'm concentrating on the two that I know are – one of those two are correct. So, you read each option one time. Don't go back and forth numerous times. So, the prompt is usually the last sentence in the vignette, or it explicitly asks the question where the prompt is – and the prompt is the most important question in the vignette. The question prompt should always be read first, because it tells you what you're trying to find out. So, you want to identify the prompt, read that, read the entire question, get in your head. Okay, in your mental notebook that you have in your head, okay, I know what's going on. So, you're focused on that question, and then you're going to go down each potential answer and decide yes or no to those answers, and then figure out which one is the best answer. So, what are the challenges with a prompt? Well, first off, your reading speed. Sometimes, if you have two paragraphs for one question, it gets to be very confusing. It's hard to figure that out. I like the paper-pencil test because you could circle the prompt, but you're not going to be able to do that with a computer. Your engagement and your comprehension will be improved when you identify the prompt. So, identify the prompt, you know exactly what they're asking, and you're going to answer that question. Finding the prompt and selecting the answer needs to be completed in your working memory. That's that 45 to 60-degree span. So, if you're in a situation where you're looking at a question and you cannot figure that question out, it's just like, oh, geez, what are they asking here? And now you're at one minute, two minutes, three minutes on the same question, you're already past your working memory. So, you've got to be very careful not to jump through. The data is very interesting in regard to this. People who change their answer on a question are most likely changing it from a correct answer to an incorrect answer. So, a lot of people will say, well, I'll – so, on your scratch pad, question number 16 is stumping you. Don't waste time on it. Move on. Just have that down that you have to go back to question 16. And you know that you have a block of time to take this exam. So, let's say that you know that you have two hours and 30 minutes. So, the – I have no idea what the blocks of time are. I have yet to receive anything from Pearson myself. I signed up for the exam as soon as they opened up the eligibility. But what happens is you want to make sure you're keeping track of your time. You're not allowed to have your cell phone there because that's a computer. So, what happens typically is that you can look for the time settings, but with a clock on the wall or something like that. But you want to make sure that you're not going to waste time on a question and stump yourself, taking away your ability to answer other questions. So, when you read the prompt, sometimes you forget it. So, it's a two-paragraph question. It's a case. And then at the end of that, you see it'll ask a question. That's going to be your prompt. And you – then as you go back up and you read the vignette, you forget what they're actually asking. So, you've got to stay alert. Some people say that they drink four cups of coffee before an exam. That may work for the first part of the exam, but coffee has a problem because it wears off after a while. And then you may have a rebound lethargy after that. So, you want to stay alert. Reading the prompt and reducing or misinterpreting it. So, you read the prompt. It asks a question. You go back and you review the vignette and you change the prompt in your head. Well, they must be asking this. This has got to be a methamphetamine exposure. This has got to be a cocaine question. And so, you tell yourself something that may not be related to the prompt. The prompt is the prompt. Try to remember that that question should be very specific when you identify the prompt. Read the prompt as stated. Do not mutate the prompt. What is the best initial treatment versus what is the best treatment? So, the key is, again, looking at that question. What is your next – what is the next thing you do? What is your next step? It's the initial process. So, we want to make sure we get a CEWA score, that police officer who is going into alcohol withdrawal. We want to get them hydrated, give them the thiamine, the folate, and we want to get them MVI. We're going to also, after we get the CEWA score, we're going to make a decision in regard to how much benzodiazepine we're going to give them. So, you're thinking to yourself, it's a logical process. You know the information. Use that information. Read the prompt first, precisely remember it, answer that question. Check back, refresh your memory in the answer selection process. So, if it's getting confusing, go back and always read that prompt. That's what they're asking. So, keep working yourself from that standpoint. In the narrative of the question, sometimes there may be information that's completely non-contributory, red herrings. They don't make any sense at all. And always go back to the prompt to try to identify, okay, what exactly is going on here? So, test-taking challenges. Sometimes your brain changes the way that you read information. So, fast reading lets the mind fill in the blanks, and you miss important words. A simple word like, which of the following is true, of the following is true except. And that word except means, obviously, everything is true except one is false. And you have to identify. I don't like those questions. They really should not be part of an exam, but contributors may put that in there. Slam dunk. When you read the question, you predict the obvious answer before you see the prompt. So, go back and read the prompt first because you may think, oh, this is obviously this answer here. But go through and read the question. You want to read quickly, but you want to read accurately. Absolute versus partial knowledge. Good test-takers exploit partial knowledge. Remember that song in Sesame Street? One of these things is not like the other? Well, that's one of the – I actually sing that song to myself. I get stumped. I go, okay, one of these things is not like the other. What is different about these FOILs? And I identify the one that seems to be most unlikely to be part of the other group. You don't have to know everything to get the question right. So, that's why I say most of us can eliminate the FOILs down to two options. Now, there's some questions you don't have any idea what the option is. And we're going to – we'll talk about that in the end. But you've got to understand that as you go through the prompt, the narrative, and the answers, you want to answer that prompt. In other words, the prompt is going to tell you what answer is most likely. You've got to trust yourself. If you say, I know the answer is A, but I think they want C, you're going to start playing this game. Now, they don't tell you who the author is for these questions. And so – and we know that there's a personality that's in each question too. And so, it depends on who wrote the question, but they should be vetted. Now, this is the first exam that's being given since, I believe, 2006. So, this exam has not had the psychometric evaluation yet. So, you are the experimenters. You are the – you're the test run. And I believe on this first run, they will be more lenient because it'll be based on how we answer the questions as a group. And so, there'll be a – when they do the psychological or the psychometric evaluation, some of us may have answers that are variant from the correct answer. But if 60 percent of us get that answer wrong, and only 40 percent get it right, that tells you that it wasn't really a very good question. If only 10 percent get it right and 90 percent get it wrong, it tells you it's a very poor question. So, we don't know what the psychometric evaluation will be. Sometimes they will actually drop questions that are poorly understood or poorly responded questions. So, let's hope and pray that that's the case and that we – that we're really evaluated on bona fide knowledge assessments. Absolute – I mean, you've got to trust yourself. The test writer is trying to trick me. So, if you're – if you start thinking that way, you've got to go back and read that prompt very carefully because the goal is not to trick you. The goal is to test your knowledge. So, questions rarely become trip questions, but they have tricky situations and tricky wordings. So, read it very carefully to make sure you're understanding what is being asked. The FOILs, if you can identify things that are not part of the – that you know are absolutely not the right answer, off with their heads. Delete them in your head or jot down, you know, which ones you're deleting. And then what happens is you can concentrate on the two or three that you're really trying to distinguish which one is most correct. Stay on course. Poor test takers are very erratic in their rationale and their methodology in taking the test. You want to stay – stay steady, stay on time, and I usually recommend that people not go back. Once you have gotten a question and you've identified it, don't go back and change it. Now, there's a couple exceptions to that. So, an exception to that would be you answer a question at the front part of the exam and then there's a question later on in the exam and you realize, hey, wait, that's right. That's what they were asking back on question 16 and you're on question 92. So, you address the question 92, but if you're not sure, that's what I'll say, if you're not really sure, jot down those numbers because you can go back and forth on the electronic in that section. Now, for those of you who are taking the primary exam, that exam is, I understand, 200 questions and the recertification exam is 100 questions. They're the same questions, we just have half as many for the research, but the reality is that you're going to be split up into two different sessions usually for the initial certification exam. And so, you can't go back to exam one when you've already completed it. So, once you hit submit, that's done, you can't change anything, but you can change things before you hit submit. Inferring versus twisting. This twisting concept is something that some of us get into trouble with. We start to put too much into the question. So, inferences are good. Okay, I think this question's on alcohol withdrawal. You draw a logical conclusion from the clues in the question. So, you read the prompt, you read the narrative, and you make an inference. Twisting though, is bad. Twisting is when you draw a conclusion from the clues, I should say clues, sorry about that, that are not logical and often require you to put in details or delete details from the question. So, you're putting in words, I think he's asking this, or you're putting in ideas, this has got to be about cocaine, or you're putting in concepts. Oh, this is a prevention question and they're talking about prevalence versus incidence. And so, you start putting things into the question that are not in the question. That's twisting. You do not want to do that. You do not want to think what they're asking. You want to look specifically what they're asking. So, words that are like but, except, or most likely are words that can trick you because you're inferring certain things, you're thinking certain things, and then there's a word that changes it. So, except, obviously, is different than the correct, if you say which of the following is the best choice, except. So, you have to be aware of those words. So, you're reading that question, read the prompt, read the question, make sure you're looking at exactly what they're trying to ask. You're looking for red flags, so abnormal vitals, fever, but sometimes it could be a complete red herring. So, you need to be aware that sometimes the question is going to be a tricky situation, not a trick question. As we've already said, eliminate the wrong answers. If part of the answer is wrong, it's wrong, and that's really important to realize as you're going through and deleting the foils. Assume the worst-case scenario, so when someone's asking a question and they have a question in regard to alcohol withdrawal being a good example, we should assume that this person is heading towards withdrawal, he's got fever, he's got hypertension, he's got agitation, and we need to intervene on this patient as quickly as possible. It's okay to guess. Now, when I say it's okay to guess, and this is what we talked about before, you can't say B is the right answer for everything because if B is an excluded foil, in other words, if you're able to exclude B, don't choose B. A lot of people say, well, I always choose B for the answers I can't come up with the answer with, but you may have already reduced it down to A and C. It's one of those two, so I recommend you pick the first of those two or the second of those two as your guess. You are not penalized for guessing. An answer that is not submitted, in other words, if you have an answer that's just blank, it's wrong. So if you know you can't, you just have no idea what's going on, pick an answer that makes sense. Now, if you say, I'm not sure from A to E what it is, if you want to pick B, that's fine. There was actually a study that was done that B tends to be right more than not. But obviously, that's after you've excluded the other possibilities. For both answers are usually wrong. So if you're looking at your five options, and four of those five have five to 10 words, and then one of them is a paragraph, a very long answer is typically going to be wrong. Answers with all, none, or never are usually wrong. The gold standard, in other words, what is the gold standard? If somebody says, what is the best treatment for alcohol withdrawal? And the option is lorazepam, Tegretol, gabapentin, or propofol. Go with the gold standard. I mean, the other, so gabapentin is not indicated. It has, there's research that shows that gabapentin can be used to treat alcohol withdrawal, but it's not indicated. It's not an FDA indication. Tegretol is not FDA indicated, and propofol is not an answer at all. So go with what you know is the gold standard for treatment. Now, if a gold standard is not available, then you have to choose what the next best answer is. Outdated treatments and harmful therapies are usually wrong. So if someone says, for a patient who comes in alcohol withdrawal, ice bath, that's an outdated treatment. Negative physician behavior is almost always wrong. So when you think about that, you know, stigma is a huge part of the challenge in treating addictive disorders, but negative physician behavior is uniformly wrong. And so keep that in mind. If you have a pictorial question, read the question and the answers before looking at the picture. Sometimes the picture, for instance, a chest X-ray, and a patient has aspiration pneumonia, you may jump to that conclusion right off the bat without looking at where the prompt is. So read the prompt, read the question, look at the options, then look at the visual stimuli. I can assume that there may be some pictures, for instance, an abscess formation, or track marks, or a splinter hemorrhage, or a Janeway lesion, or a rough spot, all indications of endocarditis. I mean, there's possibilities that would be there. But I would tend to think that most of our prompts, or most of our questions are going to be straightforward printed questions. Check units carefully. So if there's a question that says that the patient presents and has a urine drug screen of 15 milligrams per ml of marijuana or THC, well, you know right off the bat, milligrams are way too much. It should be nanograms. And so always check your units carefully to make sure they make sense. Don't waste too much time on calculations. So I'm hoping that there's not going to be a Henderson-Hasselbalch equation in there. I sure hope not. I'm hoping that we're not going to have too much lab because you get lost in the weeds. So if they have a chem profile, and a CVC, and a urinalysis as part of your prompts, it's going to be an issue. Now we know that, for instance, a verbal question, a good example would be a patient presents with intoxication, but they have on urinalysis calcium oxalate crystals. Well, you know that's going to be from ethylene glycol. We talked about that as one of the toxicology type questions. So you want to have your knowledge set matching your performance on the examination. So check units carefully. Don't waste too much time on calculations. Guessing is okay. B and D seem okay for guesses. Again, if you've excluded those as being obviously wrong, don't waste time and keep an eye on the clock. Don't look at the clock every five minutes. But I mean, if you've got 50 questions to go and there's only 25 minutes left, you got to turn on the speed here and get this done because an unanswered question is a real problem because it's going to be wrong no matter how you cut it. Last tips. Now, when I put this course together, it was before Pearson had decided to make this a virtual exam. So all of us should be receiving information from Pearson telling us how to sign up for the exam. I received my letter from the AOA from John yesterday indicating that, and I've been calling every week for the past eight weeks, that I have been approved to take the exam and that Pearson will be contacting me. I've yet to receive an email from Pearson. But what I understand is that the exam will be given remotely. I will be sitting in front of my computer. I will not be allowed to have access to other things. Evidently, they can watch me when I'm doing the exam. I have to have ways to verify who I am. Now, back in the days when we were going to take the exam at Pearson, you had to have an ID to get there. You get a little key for a locker. You throw your cell phone and all your other things inside there. I'm gonna recommend that when you take this examination, that the room you're taking it in be devoid from a lot of other distractions. So if you have a dog that's barking or if you have other things that are going on, I'm walking out on the patio and I've got two squirrels running around. So this is not a good place for me to take an exam. But I wanna make sure that I have minimal amounts of distractions in the room. I want to dress comfortably. I want the ambient temperature to be comfortable. You don't want it to be too hot. They should allow you to have a scratch paper that you can put your notes on. They do allow you to, most times Pearson will give you a test run just to give you an idea of how to use the computer system. If you're not used to that system, make sure you get very comfortable. If you do not have a computer in the house, that's gonna be challenging. So you need to have some kind of electronic system to be able to complete and respond to the exam. Every question has a stem. Every question has a prompt. You wanna look for that prompt. And again, like I said, they should be alphabetized foils. So we want to accurately and consistently read the prompt. I've said that numerous times. We wanna read the question in a consistent manner. As physicians, we consistently practice this way and we should be able to apply that process to us. We always get the chief complaint, the history of chief complaint, the past medical history, the physical examination, differential diagnosis, make a diagnosis and we treat. It's very similar. We identify the prompt. We read the question. We look at the options. We eliminate the options that are obviously wrong and we identify what we feel is the correct answer. Think about your strategy. How do you read questions? Your cognitive wiring, your working memory. Sometimes it has variables. If you're taking the examination, you're thinking, oh my God, my neck is killing me. My back's got a spasm in it. If you need to stand up and stretch, stand up and stretch. Do what you need to do. You're not gonna get to run around the house, but you are gonna be able to get your head back in the right place. Take advantage of your careful reading. And then remember to try to stay alert the entire time. You wanna streamline the way you address the questions. Typically, it's gonna be 200 questions for the initial exam, 100 questions for the research exam. Based on the little data that we have, you wanna get adequate sleep for the week prior. Don't say, well, I got seven hours sleep the night before, but you only had three hours sleep each night before that. Appropriate nutrition. I like to say always have a little hard candy or something next to you. The Pearson does allow you to have that. Have a glass of water that you can drink. I would avoid alcohol for the two or three days prior to the examination. And if you're using lots of caffeine, remember, caffeine has a lifespan, the half-life. Now, for the recertification exam, a cup of coffee, two cups of coffee may make you a little bit more alert for that short exam, even if it's two or three hours. But you may not have that capacity. And sometimes if you're using a lot of coffee, it wears off pretty quickly, and you have a rebound lethargy. So you wanna make sure you watch for that. Pearson, when you took the exam at their facility, would allow you to have bathroom breaks, but no extra time. I don't know how they're going to do that when you're at home. So I'm not sure how that process is going to be. Maybe we'll hear from the chat if other people have information yet. And you wanna make sure you're on time. So if they tell you to start at 10 o'clock or 8 o'clock, you are there early, you're rested, and you're prepared to start. So I believe that is it. I've got some references that talk about test-taking strategies from the psychological literature. And then I'm gonna open up, I'm gonna stop sharing and get to chat. So Nina, I'm ready to go ahead and start the chat process. So where, there's chat. 31 chat questions already. Okay. Can you take Q&A one, Dr. Decker? Sure, go ahead. So there's a Q&A here. You can open it up and see it. But the first one, question that we have on that one says, will we be required to know the chemical molecular structures? And I've been getting hung up on the receptor questions. L-E-D-X-M is a sigma receptor agonist. Bupropion is a CYP2D6, et cetera. Anyway, getting one sheet of them in a high-yield format. So I don't, I know you, if you answered this earlier, when you were talking about not knowing specific questions. Yeah, because all of us who contributed to the review course are not, we did not submit any questions for the exam. So we cannot tell you what's going to be on the exam. Now I've taken the initial exam way back in the 1990s. I took a recertification exam in the 2008. 2008. So I've been due to have my exam, but they just didn't have an exam. So I have taken the exam from the AOA twice in the past. I do not recall any molecular structures being on those two exams. So we gave you molecular structures. I know that you had the opioid structures. We had the benzodiazepine structures. We talked about the breakdown of opioids. I think you may need to know, for instance, that hydrocodone does metabolize into hydromorphone. So it goes from Vicodin to Dilaudid. So those types of things, I think would be worthwhile to know. And that's in the UDS and toxicology lecture that I did. That's online. But I don't recall ever seeing any molecular structures. That doesn't mean it won't be on the test, but I would tend to think that's just too much detail. Now, I do think it's important to know for heroin, it is diacetylmorphine. Heroin is when you put two acetyl groups on the morphine molecule, and then it is more lipophilic, and it crosses the blood-brain barrier faster. But again, that's a knowledge-based question that does not require the molecular structure. I see the chat questions too, but go ahead, Nina, if you have any questions. Okay. Another one, somebody else sent a link that said, John Yelton, who is the person at the AOA, sent a link to Pearson, and we are given a full list of musts. So evidently, that Pearson is sending out lists of musts to do. Another question, and just so that you know, Dr. Decker, I put a link into the chat box. On the AOA certification site, there's links that he has all of the breakdowns, and then some information about the tests, so that's all in the chat as well. And then another question was, will we get genetic and trade names or a table where we can look them up? Say it one more time, will we get what? Sorry, will we get genetic and trade names or a table where we can look them up? I believe that all the medications will be generic. So you will need to know that lorazepam is, the Ativan is lorazepam and the Valium is diazepam, those types of things. So now they may have the generic name. The generic name is the rule. So they may include the generic name and then parentheses a brand name. But I know that the generic name will be part of all questions in regard to pharmaceuticals. Now, there's a comment, oh, go ahead. Oh, Dr. Kushner said she, the letter sent yesterday from Pearson evidently, says not allowed scrap paper, food or beverages. Okay, that's gonna make things a little challenging because we all have a mental notebook. So we can mentally remember that B and C are obvious foils. And so therefore only A, D and E are options. But it's gonna be difficult because if you remember a question on cocaine and then you pick up another question 50 questions later, and then it reminds you, oh, wait, I think I may have answered that wrong. Remember number one, most times when you change an answer, you're changing it from the correct to the incorrect. So I would strongly advise you address the question you're dealing with, focus on it, answer the question and don't go back to it. To me, it's like a roller coaster ride. It's gonna be scary when you flip upside down, but you gotta worry about the next curve. You don't worry about the one you already went through. So my thing is I just, what I do is I just chop through it. Now, if I leave a question blank, because I don't have a clue, I may just go ahead and choose a B or a D at that point in time. I recommend you decide B or D for the whole exam for the ones that you don't have a clue on. But like I said, if I've already excluded B, then I'm gonna pick a different answer. But if they're not gonna allow you, and I see the note here, nothing to eat or drink, no bathroom breaks, it's gonna be tough for these old guys like me. But I mean, it is what it is. There's one 15-minute break. It's 200 to 220 questions according to the AOA and one 15-minute break. Well, I think that break, is that for the research or for the primary certification? Because I don't think you're gonna get a break with the research exam. Oh, I see. There's only gonna be 100 questions and they're probably only gonna give you either 90 or two hours to do that section. It says here, 200 to 220 questions, 15-minute break. I see that there. Okay, other questions you have, Nina? I don't have, it says- I'm gonna go back to the chat. I'm gonna go to the top of the chat line here. Yeah, go ahead. Okay, so it says here, 99.5, okay. Oops, just reading all the highs here. Okay, so you included the link. That's great. And please, review that link with the questions, the percentages for each topic, because that's the exam. They're telling you exactly what they're gonna ask. And the way we taught the course was towards that list. So if there's 14% on alcohol, we weighted the presentations towards that percentage. So that's an important link to have. You can't have anything to eat or drink, no bathroom breaks, okay. Yeah, that's all I have here. So I don't know if I had any other topics or questions. If anybody else has another question, please feel free to ask. I mean, I think the fact that- There's a question about any other board questions. And I know we have some references about the ACM questions that are part of our, we have a reference page on our website you might want to refer to about where people can find some practice questions. So there's a book that's put out and Abigail Herron, who's a DO, is one of the editors. It's called Essentials of Addiction Medicine. Hold on, I have a copy of it right here. Let me get it. So it's a good thing I wore pants. So that's the book right here that I strongly recommend. At the end of each chapter, they have three or four questions that are applicable to that chapter. It's what I'm reading for preparation for the exam in addition to listening to all the presentations. But I strongly recommend that if you can get this, it was only I think $70 or $75, but it's an excellent text. It reviews each topic very thoroughly, and it has a set of questions at the end of each section, and there's over 117 sections. So you're going to have about 400 questions to review, and I'm going through those questions myself. So I'll put that back up here for people to see. Nina, anything else coming up? No, I have no other questions that are on here. There's a comment. I have been getting daily questions on addiction medicine from statpearls.com. There is a free version. There's a note regarding that. Okay, good. Well, I really appreciate everyone's interest in the field and the efforts that people are making to take the certification exam. Like I said, this is the first time in psychometrics will determine what will happen for the second exam. The second exam, I believe, is going to be scheduled sometime in late spring 2021. The American Board of Preventive Medicine, ABMS exam has already had over 6,000 people who've gotten certified. So addiction medicine certification has become the rule, not the exception. Okay. With that in mind, I have no problems with people contacting me. I'm putting in my cell phone here. And I do appreciate if there's questions. Just to give you a response though, because I've had several people call, is this going to be on the exam? I say, well, go back to that list. That list will tell you what's on the exam. But I can't tell you what the actual questions are because I'm taking the exam too, and I have no idea. I don't even know who the contributors are for the exam besides I think Dr. McNerney is the only one that I'm aware of. So I think the goal here is to stay on course. But the test-taking strategy to me is be in the right frame of mind. We all know what it's like. It's high stress for a lot of us. We're going to be at home, so it's a little different situation. And you don't want a scenario where a person says there's a test impropriety. I'm 67 years old. I can last two hours pretty well, but four hours would be tough. And so I think that you don't want to create a scenario. So empty that bladder before you sit down. Be ready, drink a cup of coffee before you get in there, and then go to work. All right. Everybody, thank you very much. Oh, you want my email too? Okay. Nina, we all set? We are all set. There was one other question about if people have a different expiration date for their recertification. There was one individual who said they don't expire until 2022. So the answer to that one would be, unless you disagree, that they do not have to take the recertification now. They can wait until they actually indeed need to recertify. Right. But make sure you check that date. Because my date was originally 2018. Then they changed it to 2019. Then they changed it to 2020. And then they recently changed it to 2021. So when I signed up for the exam, they always said, well, you're not due to take your recertification. I said, listen, I just want to get it over with. I said, I'm ready to take it. I just want to do it. And then they said, well, you're taking a year early. And John from the AOA certification, he said, okay, if that's what you want to do, that's fine. So my thing is, I just want to get it done with. I'm getting to be an old fart. I don't know what my head's going to be like next year. Gmail isn't showing. It's ADECR1007 at gmail.com. And ADECR is A-D-E-K-K-E-R. Did it not show come through? You know what happened? I just, I just re-sent it. You put it to all panelists and not all panelists and attendees. So everybody should be able to see it now. Got it. Okay. Oh, I see what you're saying. Okay, good. All right. Well, good luck, everybody. Thank you, Dr. Decker. All right. Take care.

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