www.thepalife.com Stem Certification and Recertification Exam Review CME Resources Clinical (Critical) Thinking Donald J. Sefcik, D.O., FACOEP Learning Objectives Upon completion of this portion of the review course, the participant should be able to: 1. Describe the PANCE "Item Blueprint". 2. Compare and contrast ''Norm-referenced" and "Criterion-referenced" examinations. 3. Discuss "Passing Thresholds". 4. Discuss "computer-based" testing (CBT). 5. List and describe common test-taking skills • Familiarity with question formats • Critical reading of questions and answers • Answering questions in a timed environment 6. List and describe common test-wiseness skills • Time-management techniques • Error-avoidance techniques • Deductive-reasoning skills 7. List and discuss methods to optimize "guessing" on standardized tests. 8. Describe methods to: • Select textbooks and study aids • Improve one's memory and enhance recall • Create student-generated, focused learning guides A 48 year-old male with chest pain .......... . Radiates into his arm; Smoker; Hypertensive; Taking "cardiac medications" ..... EKG demonstrates ST segment elevation ..... . Options A) Podagra B) Pleuritis C) Costochondritis D) Pericarditis E) Myocardial Ischemia
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Clinicial Thinking and Test Taking PANRE and PANCE
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www.thepalife.com
Stem
Certification and Recertification Exam Review CME Resources
Clinical (Critical) Thinking Donald J. Sefcik, D.O., FACOEP
Learning Objectives
Upon completion of this portion of the review course, the participant should be able to:
1. Describe the PANCE "Item Blueprint". 2. Compare and contrast ''Norm-referenced" and "Criterion-referenced" examinations. 3. Discuss "Passing Thresholds". 4. Discuss "computer-based" testing (CBT). 5. List and describe common test-taking skills
• Familiarity with question formats • Critical reading of questions and answers • Answering questions in a timed environment
6. List and describe common test-wiseness skills • Time-management techniques • Error-avoidance techniques • Deductive-reasoning skills
7. List and discuss methods to optimize "guessing" on standardized tests. 8. Describe methods to:
• Select textbooks and study aids • Improve one's memory and enhance recall • Create student-generated, focused learning guides
A 48 year-old male with chest pain .......... . Radiates into his arm; Smoker; Hypertensive; Taking "cardiac medications" ..... EKG demonstrates ST segment elevation ..... .
Options
A) Podagra
B) Pleuritis C) Costochondritis
D) Pericarditis E) Myocardial Ischemia
Standardized TestingScoring Analysis
Norm-ReferencedRaw Scores are converted by using a reference group
ExampleMean of Reference group converted to 500Standard Deviation of group canvertedto 100A11 other scores then converted to this standard.
Results: 67Yo of scores:400-600 (500 +/- 1 SD)97Yo of scores :300-700 (500 +/- 2 SD)99% of scores:200-800 (500 +/- 3 SD)
Pass/Fail Threshold -** If use I SD below mean:
-t6%
"Failare" -84o IPASSI
MEAN
Criteria-ReferencedIndependent Standards-Setting C ommittee
** Passing Threshold established BEFORE the Examination.
* * All may pass. . ...or. . . . . . all may fail. . . . . ...
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Test-Items
Multiple Choice Formats
1. A-Type Items
o Commoniy referred to as: Multiple Choice euestions. Majority of Certifuing Examination euestions
Tlrpical Question
STEM: A 35 year-old male presents to your faciiity with..... ..
OPTIONS: (Letters)* Correct Answer or Best Answer* Distractors (incorrect options)
Stem may be a question.. Requires a completed thought.. Pay attention to objective.......most likely, etc.r Generally are written in the positive.
Words such as: Except; Least; Not; etc. are avoided.
Stem may be a vignette.r Short scenario --i sg^t.^"e-, or le€! {ti - S z % ). Long Scenario
KEY: Focus on the associated variables. .. ....and what you are being told.
2. B-Type Items
r Commonly referred to as: Matching euestionsr Minority of Certifying Examination Questions
Tygical Ouestion Set
OPTION SET: Organized around a theme
MATCHING ITEMS : Q.trumbers)
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Test-Takine Skills
1. Think like the Test Constructor
Test Ouestion Constructor's Task
Common Format (Type A). Stem - Presents the problem (question)
o Responses (answer and distractors)* One Correct answer ot BEST qnswer
* Distractors
a. One choice obviously incorrectb. Two choices reasonable (peripheral to topic)c. Two choices correct (but one is BEST answer)
2. Think like a "test-wise" test-taker
Test-Taker'sTask
a. Get rid of the Obviously Incorrect answer
Probability alone now (4 choices remain) = 25%o correct response
b. Split the remaining four responses into reasonable (2) vs correct (2)and disregard the two reasonabie responses
Probability alone now (2 choices remain) :50%o correct response
c. Select the BEST answer of the two remaining choices
Just like "Dffirential Diagnosis"
Example
A 52 yearold male with shorhress of breath"Hurts more to take a deep breath".....No history of trauma; pain is not reproducible with palpation... . ..Pulse oximetry (room afu) : 88%; Percussion reveals tympany; trachea is deviated......
Options
A) erosive arthritis
B) pathologic rib fracture C) costochondritis
D) tension pneumothorax E) pulmonary embolism
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3. Test Taking Principles
A. Focus on the stem.... it sets the task !!!(finding the BEST answer)
B. Read ALL options before recording your answer.(avoid partly correct responses)
C. Go with your instinctive feeling.(you picked it for a reason)
D. Once you decide an alternative is incorrect, do not consider it again.
E. Avoid "READING INTO" the Question(the stem sets the task)
F. When GUESSING is the ONLY alternative:
1. General Alternative -If fow of the five options are very specific and one very general....Often, the more generai option is the correct response.
2. Longest Alternative -Often, the exam writer wants to be sure you have enough information torecognize the correct answer.
3. Opposites & Similar Alternatives -If two choices are very similar, usually the correct choice is NOT one ofthem. The correct response IS often one of two opposites.
4. Grammar Agreement -The stem and responses should be grammatically correct.....Singular stem should not be completed with a plural option.
5. Specific Determiners -The implication of absoluteness (Always, Never, Must, None, On1y.,.)is often incorrect. Words that permit exceptions (seldom, usually, oftenperhaps, etc) are more commoniy associated with the correct response.
6. Rank Order -When a list of numbers or oorank ordering" exists, the correct response isoften somewhere in the middle,
7. Which of the following "sets"........A.W&X; B.Y&Z; C.X&Y; D.Y&Z; E.x&Z
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lnitial PresentationEmergency Tx
Continued Tx Follow-up
1. History-TakingPhysical Examination
a. Pertinent H/PE* Pathognomonic* Risk Factors
b. Techniques* SignslTests
2. LaboratoryDiagnostic Studies
a. Selection
b. lnterpretation
c. Predicted results
3. Most Likely Diagnosis
a. Based on data* Verbal* Pictorial
4. Prognosis (Severity)
a. Current Status
b. Projected Status
c. Consultants
5. Therapeutic Management
a. Medications* Drug(s) of Choice" Contraindications* Side Effects* lnteractions