All right, Julie, let's go ahead and start. The first speaker is me, and we'll be talking about test-taking strategies. So I have no conflict with the subject of this talk. And again, you're here because you're either sitting for the subspecialty certification exam or you're taking the MOC combined sports pathway. You know, these exams are very, very similar. They're developed and administered by the American Board of Orthopedic Surgery. And a quick disclaimer, I'm going to make comments about the exam, but I do not represent the ABOS. You know, I'm not on the board, and I'm just giving you my impression and best knowledge and understanding of how things work. So if you question about anything more about the exam that I can't answer, please contact the ABOS. They're very helpful in this regard. So, you know, if you're sitting for the subspecialty certification, you know, you've completed a one-year ACGB accredited fellowship, you've submitted your one-year case list, the bulk of your operative cases must be arthroscopy, and you've had letters of recommendation to support your application. If you're taking the MOC, as you guys know, it's only available to those candidates who currently hold a subspecialty certification. And this renews both your general and your subspecialty certification in orthopedic sports medicine with one exam. That's nice. And the renewal is good for 10 years. So in the past, the MOC exam was 120 sports medicine questions, 80 general. That was changed, I believe, last year. It's now 175 sports med questions. There are no general orthopedic questions in the MOC exam. So the exam's makeup is essentially the same as the subspecialty certification exam. So this exam's designed to evaluate the candidate's cognitive knowledge of clinical surgery of sports medicine and the basic science relevant to surgery of sports medicine. It's a four-hour exam. It's timed, and it's administered by computers in a Prometric Center. We're gonna talk more about that. So the exam makeup. General principles is 6% of the exam. So that's research questions, study design, statistics, ethics, professionalism. Those type of topics make up 6% of the exam. Medical sports medicine, that includes non-orthopedic complications of surgery, such as infection and PEs and DVTs, make up 16% of the exam. And then you can see the musculoskeletals, 78%. Roughly 40 to 50% of the lower extremity questions are knee, and roughly 40 to 50% of the upper extremity questions are shoulder. So you can see knee and shoulder dominate the exam. So the exam, there's a 15-minute tutorial at the beginning of it that walks you through how to take the exam. And then you can see there's four exam sections. Each of them is 60 minutes. And the first three are 44 questions, and the last one is 43. And there's a survey at the end that asks you to provide feedback on the exam. I'd like to spend a little time, we won't be talking about this tutorial. All right, so it's a four-hour exam, four one-hour blocks, roughly 44 questions each. In the old exam, you only had 72 seconds per question. In the new format, you have 82 seconds. So actually, that's another benefit of the new format. There's no penalty for guessing, so answer every question. So how do you determine a passing score? Well, the raw scores are tabulated, and there are poorly performing questions. We'll talk more about that in a little bit, but that can be up to even five or 10% of the questions. So these are discarded and replaced every year. So there's 10 to 15 physicians of the American Board, and they do this content-based standard-setting exercise. So they set the standard for passing a failure. So what are the results? Well, you can see in the certification exam, started back in 08, that for the first seven or eight years, the pass rate was upper 80s, lower 90s. But in the last three years, you can see that the pass rate has increased 95, 98, even 99%, and we hope that this course has helped contribute to that. So in the MOC, you can see also a very high pass rate in the MOC sports combined exam. So general preparation comments, pay attention to the schedule, especially if you're the MOC route, you know that. Be aware of that pathway and each step it takes to get to the exam. I recommend you sign up at the test site early and have some type of study strategy. So again, MOC schedule, I won't spend a lot of time with that, but if you're taking the MOC, make sure you understand that. Now, the prometric sites. Now, these are private, for-profit testing centers that are across the country, and there are competing exams. So don't assume that if you're gonna take your exam on Saturday at eight o'clock, that you can walk in there Saturday at 7.30 and sign up for it. Your state's hairdresser licensing exam may be that same day, and they have no computers available because all the hairdressers are sitting there taking their licensing exam. So sign up early. If you get boxed out of one prometric site, you may have to find another one that may be further away. So use the prometric website to find the site closest to your house, the most convenient one. Sign up early, lock in your spot. Prometric claims that 95% of test takers are less than 50 miles or within 50 miles of one of their sites. But you just wanna make sure you don't get locked out of your preferred site. So any examination is a test of your skills in two areas, your knowledge and application of the material, and the skill and familiarity with the test-taking process. So let's talk about pursuing, maximizing your knowledge and application of material. You need some review materials, and you can identify that, each one. It can be OKUs, the Journal of the AOS Review Articles. You can look at textbooks. You can do board review texts. And then there's even online orthopedic review rate sources that are available. So identify your review material, and then there are practice tests. I'm a big believer in these practice tests. I think there's a lot of bang for your buck on those. So the best ones, I believe, are the self-assessment practice tests. In fact, if you're taking the MOC, these are required. You need to take these, you need to sit for the exam. The Academy has print and computer-based self-assessment exams, and the AOSSM puts one out every year. So what's nice about these self-assessment exams allows you to review your missed questions. And each question is a commentary section. This is of great value. Don't skip this. Even if you've got the question right, read the commentary, because the commentary should be explaining why the right answer is right, and why the wrong answers are wrong. And if you've ever been participating in these committees writing exam questions, there's only, for a particular topic area, there's only certain areas of non-controversial questions that can be asked. So if you go through these self-assessment exam questions, you should have a good sense of the concepts that are testable in each of these different areas. The self-assessment tests also provide references if you want to dig a little deeper. So one suggestion is take 20 to 30 practice exam questions every three to four days. Identify any weak areas you might identify in yourself, and then you may modify your study plan. So set up a study schedule. If you're gonna use text, maybe skip areas that you have good knowledge of and pursue those you're less comfortable in. Set yourself up to do X number of chapters per week. If you're doing the OQU, you may want to do X number of pages per week. Decide which of your oracles you want to look at for areas you might be a little weaker in. And the big area, I think, of these self-assessment exams, you may want to do X number of questions per week. So how about skill and familiarity with test-taking? All right, so you want to be familiar with the location, have some familiarity with the mechanics of that computer exam. So know the location. I'd recommend you drive out and find the testing site. See how long it takes to get there. You do not want the stress of the morning of the exam getting lost or being late. So know where it is and how long it takes to get there. So you may want to see what the test-taking booths look like. And you can only take your ID into the exam. Pencil and paper will be provided, but you're required to leave the pencil and paper behind. There's no food or drink in the testing site, but if you bring some food and drink, you can access them from your locker during the break. So know what to expect. Don't think you're gonna walk in there with your favorite lucky number two pencil and your favorite yogurt and a cup of coffee and sit there and take the exam, sipping your coffee, holding your lucky number two pencil. You know, that type of thing's not gonna happen. You don't know what the process is going to be like. So familiar with the exam. So practice tests, we're gonna come back to that. ABOS has a tutorial and a practice exam. So be comfortable with the test format and the tools of the computer-based exam. So we'll talk more about this tutorial and practice exam. So here's, if you go to the ABOS website, you'll find this subspecialty certification in sports medicine, the tutorial. Strongly recommend you go through this. This is the tutorial that, remember when I showed you the format layout for the exam, that there was a 15-minute tutorial. You can take that 15-minute tutorial the morning of the exam, but you can also take it tonight or tomorrow, next week, whatever. I recommend you take it at home prior to the exam, work your way through it, and it shows you some things like this. It shows you how to calibrate your monitor as far as contrast and brightness. It talks about your audio calibration, should there be audio in the exam. Instructions for how to use your mouse, what the mouse functions can do during the exam. It shows you how the keyboard functions work. The toolbar. You don't wanna be struggling trying to figure out how to use the toolbar in the middle of your exam, right? You got 82 seconds per question, you're trying to figure out how to use the toolbar. No, take this tutorial a couple days prior so you understand how the toolbar works. And understand how the timer works, because this is a timed exam. Once you start, you got 60 minutes. At the end of the 60 minutes, click, it shuts down. So make sure you understand the timer and how to keep track of where you are in your timed block. How about ending a block? How do you end it voluntarily and what are the consequences of that? What about an authorized break? At the end of the block, you can take a break. So how do you do that? How do you leave? How do you reenter after the break? What about an unauthorized break? You're in the middle of your section number two, you're at 60 minutes and you have to use the restroom or something, you take an unauthorized break. How do you take an unauthorized break? And what are the consequences? The consequences are the 60 minutes doesn't stop. So you have 60 minutes for those 44 questions. If you leave with an unauthorized break to do whatever, that 60 minutes is still clicking away. So if you do take one, how do you reenter? The tutorial explains all that. How do you get back in? How do you use your candidate identification number, your CIN? What are items prohibited? Pretty much everything is prohibited from going in to the exam area. And what about these warnings? Be aware that these little warning boxes will pop up. So they're mostly just giving you some heads up. You got five minutes left in your block or something like that. So you understand who's gonna come. Don't be in the middle of the exam, all of a sudden freak out because this big warning box just popped up and you think you did something wrong. So how about marking an item? How do I mark and unmark a question I may wanna come back to? Understand how to do that ahead of time. Again, the tutorial walks you through all of these things. How about advanced next question? How do you go back to the last question? How about a calculator? If I wanna make a quick calculation. They do provide a calculator. How do you access it and how do you use it? Again, you don't be fumbling around, figure that out in the middle of the exam. Know how to do it ahead of time. So as part of that tutorial, there's also a practice exam. And so the ABOS provides these 15 sample questions. And really it's not getting them questions right. It's all concentrating on how to learn, use the software, practice on that question, doing this, doing that. And you kind of go through the, get familiar with how to use the software in the computer. So here's an example of one of their questions. So the ABOS practice exam, it's a good idea for prep and I strongly recommend it. Now, what about some general test taking strategies? Well, this is pretty common sense. You guys are all accomplished test takers or you wouldn't be sitting here in this situation. You know, the night before the test, you don't wanna take call. Make sure you get to bed on time and make sure all these psychosocial family of practice issues, you've got those resolved and you're not sitting there fretting about those night before the test. You wanna be well-rested and focused. Start your day as you always do. Eat a good breakfast and think positive. Multiple choice questions. Read the question and all the answer options before you mark anything. And remember your first guess or your first inclination is often right. Pace yourself. Don't spend too much time on only one question. Do your best and move on. Try to answer every question, make the most intelligent guess that you can. So process of elimination. Don't guess blindly if you have time to think about the best choice. If you can eliminate two wrong answers, your chance of choosing the right answer is obviously greater. So if you finish early, check to make sure you've answered all the questions, make sure you've left none of them blank and revisit questions you have some knowledge of but you're unsure. That's a type two question. We're gonna talk more about type one, two and three questions here in a minute. Look for key phrases and words in the question. Often those are, you see these certain key phrases that kind of tells you what to look for. For example, they talk about a blow to the anterior flexed knee. Right away you start thinking PCL as soon as you see that phrase. Read the passages. If the test requires you to read a passage and then answer questions about what you read, if you read all the potential answers first, you look through the answers, now you read the text. What that does for you, you'll know what you are looking for as you read the text and this also helps you go faster through the exam. So here are the three types of questions people typically talk about when they take an exam. Category one, you know the answer. Dead nuts on, you know it. A category two, you're somewhat familiar, you can narrow it down to two or three possibilities. Category three, you have no idea what the heck the answer is. So category one, you're certain the answer, you read it carefully, answer quickly, but don't return to it. Category two, you narrow it to two or three possibilities, spend your most time here. Try to eliminate the obvious distractors. Distractors are wrong answers. And review again if you have time at the end of the exam. Category three, you have no knowledge, no idea. Guess, make your best guess. There's some guessing strategies and then move on. Do not return. So category one and three, do not return. Category three, yes, spend a little extra time on it. Here's a category one question. Preferred treatment for an isolated, non-pathologic, mid-shaft, closed femur fracture in a healthy adult is? Locknail. So we all know that. Answer it, go on, don't come back. Here's a category three. The gene coding for achondroplastic dwarfism is located on chromosome number what? And you're sitting there saying, I have no idea. You could sit an hour and sit and think about that. You're wasting your time, right? So you know how to guess and move on. How do you guess? Typically we avoid the extremes, get rid of the ones at the other end and then just pick your number there, your lucky number. So guessing strategies. Delete the odd man out. Here you got all the rotator cuff muscles in the quad. So obviously you get rid of the quad and go from there. An example of a category two. A healthy 18-year-old male is brought to the trauma emergency department with an isolated grade three open femur fracture. His vascular coma scale is 15. He's moving all extremities. His abdominal exam is benign. His extremities are well perfused. His blood pressure is 80-40. His pulse is 135. His ECG is unremarkable except for a tachycardia. The most likely etiologies for hypotension is, and you may be sitting there thinking, wait a minute, I don't know any trauma. What are you, he's low blood, what's that all about? Well if you sit and go through it, for example, his abdominal exam is benign, all right? So I think a benign bleeding's out. His vascular coma scale is 15. That's normal, so he doesn't have a subdural. He's moving all his extremities, so he doesn't have a spinal cord injury, so that's not neurogenic, so all of a sudden you knock those out. He's only 18 years old, and his ECG's unremarkable, so it's probably not cardiogenic. So your resulting answer is blood loss from movement fracture. So even though the answer doesn't jump out to you right away, if you sit and look at it, you can start to narrow down your options. Now the bad question. So the key purpose of a question is to differentiate, right? Whoever put the exam together, they wanna know who's knowledgeable about this area and who's not. So if a question has less than 50% of the test takers getting it correct, that means the high scores and low scores perform the same on the question. This indicates there's a lot of guessing going on. It's not differentiating, and that question is discarded. So remember I mentioned before that these bad questions can total as much as five or even 10% of the exam. So if there's a question you're convinced is a bad question, don't spend too much time on it because you're very likely it's a question that's gonna be discarded, and you're wasting your time on a question that's not gonna be calculated into your final score. So general tips. Answer the easy questions and don't revisit them. Some later questions may help you remember more difficult earlier questions. Go back and revisit your category two questions. Answer all the questions, there's no penalty for guessing. Use all the time allotted. When guessing between two, often use your first answer or your first impulse. If an answer seems obvious, it probably is. If two or more answers are essentially the same, both will be wrong. If a two appear to be correct, choose the one that causes the other to occur, okay, which is the prime one. Consider ethnicity, race, gender, age, geography, and occupation when reading case studies. Don't get hung up on a bad question. Now don't sit there and assume 120 questions are bad either, so. These will likely get tossed. All right, thank you and good luck. Thank you.

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