This is a talk that doesn't have anything earth shattering, but I think it's maybe somewhat reassuring to everyone. So this is the test taking strategies for the ABOS subspecialty certification in sports medicine exam. I want to recognize Brian Bosconi. He gave this talk for several years and I took it over a year or two ago. So he put a lot of that together. So I have no conflict with his talk. So there are two exams. There's the orthopedic sports medicine subspecialty certification exam. That's for people taking it for the first time. And then there's the MOC. I think most of you here are taking that MOC combined sports exam. The exam's developed and administered by the ABOS. This course is sponsored by AOS and AOSSM. We're not representative of the ABOS. So a lot of people after this talk run up and they ask me these questions about the exam. I can tell you what I know, but I don't represent or sit on the American board. And they're the ones who do the exam. So the subspecialty certificate, the applicants have to complete a one-year ACGME accredited fellowship in orthopedic sports medicine. I think you guys that are certified in MOC have already done this. You submit a one-year case, 115 operative cases and 10 non-operative cases. Seventy-five of the 115 must involve arthroscopy and then typically some letters of recommendation. For the MOC, the combined sports exam, this is only available to candidates who already hold a subspecialty certification in orthopedic sports medicine. And it renews both your general orthopedic and your subspecialty certificate in orthopedic sports medicine with one examination. So that's nice and that's very convenient. Then this renewal is good for 10 years. If you do the MOC, I'm sure everyone here is aware of that timeline of what needs to be met. It's a very well-defined schedule. And if you haven't, I encourage you to go to the ABOS website and review this. And ultimately, you either take the computer-based exam, which is what we're preparing you for here, and there's also that web-based longitudinal assessment option. So this is the area of that schedule that we're focused on. So to make up the exam, until recently it was 120 sports medicine questions and 80 general orthopedic questions. Well, currently it's 175 sports med questions and no general orthopedic questions, although you can debate what's sports versus general. So the exam is designed to evaluate the candidate's cognitive knowledge of clinical surgery of sports medicine, basic science relevant to the surgery of sports medicine. Again, 175 questions, four hours of time are allotted to complete the exam and it's administered on computers at a pro-metric center. So exam makeup, general principles of 4 to 8%. That's biostatistics, epi, medical legal issues and basic science principles. Musculoskeletal is 78% of it with the lower extremity being about, you know, 40 to 46% of that. Upper extremity, you know, 30%, spine 2 to 6%. Multiple sites are 13 to 17%. That means medical aspects of sports, multi-trauma and complications from surgery and some type of tumor question is just 1% of the exams. So you can see that ultimately a good portion of the musculoskeletal portion, which is the bulk of the exam, is knee and shoulder. So when you take the exam, the first 15 minutes are tutorial that the ABOS exam walks you through and then there are four 60-minute sections with roughly 44 questions in each. At the end they ask you to complete a survey. They want some feedback. So a four-hour exam, four one-hour blocks of 44 questions each, you get... that comes out to about 82 seconds per question and that may sound pretty fast, but the old exam was only 72 seconds per question. So that's actually better and there's no penalty for guessing. So you must... You should answer everything. So determination of the passing score, the raw scores are tabulated. The poorly performing questions and that can be as high as 5% or even 10%, they're discarded and they're replaced the next year. So apparently there's 10 to 15 physicians that review all the questions and they do this content-based standard setting exercise. They confer and they determine a common passing score, a pass-fail line. So for the sports medicine certification exam, you can see the pass rate, that should be a 2014, not 2024. You can see in 14 it was 92 and then it got as high as 99 and last year it was 96. That's for people taking the exam for the first time. For the combined recertification exam, you can see that it's roughly 98, dipped down to 96. Last year it was 99. So a high pass rate, but there are some failures. So general preparation comments, you know, pay attention to the schedule for the MOC. Any questions, call the American Board or it's pretty well deleted on their website. Make sure you get your CME done. They require, you know, 20 from the self-assessment exams. Get your case collections done a year prior to it. Sign up early for the test site. And have a strategy for how you're going to study for the exam. So the Prometric sites, if you haven't been to one, sign up early, go to the Prometric website. You're going to find a site that's close to you. Prometric claims at 95% of test takers are less than 50 miles from the site. So if you're in a decent-sized city, there'll be a Prometric location for you. But you have to remember that the cosmetology people and the hairdressers and the barbers and the firefighters and all these people that are licensed by the state, they're all taking certification exams too. So the Prometric site only has so many computers. So you want to make sure you don't get boxed out by the hairdressers. And you can't take it on the time you want. So sign, reserve your site early. So really, an examination, and Lord knows everyone in this room is taking a lot of tests, is a test of your skills really in two areas. First, the knowledge and application of the material. But the second one is your skill and familiarity with taking the test. So let's talk now about knowledge and application of the material. So review material, you know, there's OKU's, there's the Journal of AOS Review Articles, the Orthopedic Support Medicine text. There's a board review text that are all of value for you. Ortho Bullets is actually pretty good. It's...they have bullet points on general topics and they have some practice questions for you. There's review material and there's practice tests. We talked about...strongly encourage you to do the practice tests. Because they will give you a sense for if there's a certain concept that wants to be tested, how that concept's questions likely to be phrased. And then what's a great value of that is the discussion and they'll explain to you what concept was being tested and why the wrong answers were wrong. So this is what I was just talking about, the self-assessment practice tests. They actually require you to do them, so you guys have already done it. The Academy has printed and computer ones and the AOSSM, I believe I can say, for four years back, you can actually do it web-based as opposed to printed. So what's nice about the self-assessment exams, they allow you to review your missed questions. The commentary section is a great value. Don't skip the commentary session. It provides references for even more detailed study. And, you know, we suggest taking 20 or 30 practice questions every two to three days. Identify your weak areas and then modify your strategy...your study strategy plan depending on... identify some areas of weakness. So they talk about recommending you set up a study schedule, you know, text, skip the areas you know a lot about and focus on the areas you don't, maybe set up a schedule where you can do X number of chapters per week, OKU, X number of pages per week, identify which JAOS articles you want to review to help fill in some deficiency spots, and then on your SAEs, you may want to decide how many questions per week that you want to do. So having a strategic plan helps you achieve your goal. Now what about the second part, having skill and familiar area with test taking? So we're going to recommend to improve your test taking skills, have familiar area with the location where you're going to take it and have some familiar area with the computer exam. So familiarity with your location, drive out and visit the Prometric Station location, see how long it takes there. Clearly, you don't want to get the stress of getting lost, haven't been there, you can't find it, traffic was bad, oh I thought it would take me less time than I did to get there the morning of. So know where it is and how long it takes to get there. You may even want to, you know, walk through it, see what the booths look like. The only thing you can bring into the exam is an ID, a pencil and paper provided, it has to be left behind, there's no food or drink at the test site, but you can access your locker during breaks, and we're going to talk about the breaks. So know what to expect, you know, so there's no surprises. There are practice exams. The ABOS has a tutorial that we talked about, and you can actually go through the tutorial, I'm going to put some highlights on that, and they actually have a practice exam. So you'll be comfortable with the test format and the tools of the computer-based test and focus on the tutorial and the practice exam. So you can go to the website, go to the ABOS site, and it'll have their examination tutorial and it'll walk you through it. It'll do things like, gee, you know, how do you calibrate the monitor? You know, so reading slides is less important for what we do, but if you're a radiologist, you want to make sure that the monitor is calibrated the way you like it. Audio calibration, how do you do that? How about mouse function? What about keyboard functions? What about the screen layout? Well, these little different buttons, what do they do, and how do you use them, and is it a button you like to use or not? So understand some of the functionality of what the test format has. So there's a timer function, and so you understand, hey, how does the timer work for this thing, and how do I use it, and what item am I on, how do I track which item I'm on, which section, how many questions am I, and have I done it, and help keep track of where you are, and number of questions, how far you are in each section, and what your timing is, what's left for that particular section. This timer function usage, reduced warning, time warning, and time expiration warning, so you have an idea of when it's going to pop up this big warning panel, so you don't panic. Oh, yeah, telling me I've got five minutes to go, that's great. So, again, just being familiar with how this test works, and you go through that tutorial, it'll explain all those things to you. So this example of ending a block voluntarily, and taking an authorized break, so they have breaks at the end of a block, and you're allowed to take some time, go off, go to the bathroom, maybe go to your locker, or whatever. You can also take an unauthorized break, but that's a problem, that's a little bit of a red flag, the clock may still keep ticking, even though you have to leave, it may flag you if there's something odd about your result, that you had some odd behavior, and it kind of walks you through and explains when an unauthorized break is in the exam. And also, you know, what's familiar, you know, what's allowed, you know, don't be, don't tell your wife, yeah, I'll call you halfway through the test, because, to find out how the dog's doing or something, you know, no cell phones, no cameras, this type of stuff, just know what's allowed and what's not. How about marking items for review, how do you do that? If that's your style, you like to mark a question and come back to it, we'll talk about that in a minute, how do you mark a question? So it'd be nice to know how to do that ahead of time, rather than trying to figure it out while you're on the timer at 82 seconds per question. And how do you advance between the different questions, how do you drop a note on a particular question, do you want to use a calculator, do they have a calculator, how do I access the calculator, how do I go through it, how do I do a, you know, multiplication or division on it? The ABS, beyond the tutorial, also has a practice exam. So this has sample items, 15 examples of test questions, you don't have to worry about answering them, it's just to go through the mechanics of actually answering them, concentrating on learning how to use the software, not the actual question itself. You can do the tutorial alone or with the practice questions, and you can run these orientation materials as timed or non-timed exams, you'll start to get a sense of the rhythm that they expect you to follow when you take the exam. So here's an example of one of their test practice questions and the format of how it works and what it looks like. So the ABS, not only the tutorial but the practice exam, it's a good idea for preparation and it's strongly recommended by them and I would endorse that, it's a good thing to go through. So what about general test-taking strategies? You've probably all taken hundreds of tests in your career and you probably have your own test-taking tips but I'll go through some of these. Obviously, don't take call the night before, pretty obvious, go to bed on time, solve family practice issues before the testing date, obviously you want to be well-rested and focused. They recommend you start your day as you always do, eat a good breakfast and have a good positive frame of mind. For multiple choice questions, read the question, all answer choices before marking anything. Another thing to remember is your gut instinct, your first guess is often right. Pace yourself, don't spend too much time on any one question, do your best and move on and we're going to talk about why that's important. Try to answer every question, make your most in telling a guess that you can and then move on. So the process of elimination, don't guess blindly if you have time to think about the best answer choice. If you can eliminate two wrong answers, obviously your chance of guessing or choosing the right answer is greater. Skip, return, check. If you finish early, check to make sure you have answered all the questions, revisit questions you have some knowledge about but are unsure, that's a type two question. And we're going to talk about the types of questions here. Find key words or phrases. I think throughout today, I think Tom Gill, some of them mentioned, boy in the vignette, certain phrases should catch out to you like dashboard or skeletal immature with an MCL valgus type injury. You know things, little phrases that you look for help you choose the right answer. If the test requires you to read passages and then answer the questions about what you read, a lot of people would say read the potential answers first if it's a longer vignette because then you get a sense for what the vignette is driving you toward. By doing this, you know what they are looking for as you read, this also helps you go faster on the test. So here's the types of questions. A category one is you're certain of the answer. What's your name? Boom, got it. Category two, you can narrow it down to two or three possibilities, but beyond that, you're not quite sure. Category three, you have no idea. So here's an example. So category one, you're certain of the answer. You read carefully. You answer it quickly, do not return, move on. Category two, you narrow it down to two or three possibilities. Spend the most time on your category two questions and eliminate the obvious distractors or wrong answers and then that's the one where at the end of the exam come back and maybe put a little more thought into it. At category three, I have no fricking idea. Guess, move on and don't come back. So do you return and review category one and three? No. Category two, yes. A category one answer. The preferred treatment for an isolated non-pathologic mid-shaft closed femoral shaft fracture in a healthy adult is... I know this. It's a rod. I answer it. No question in my mind. No brainer, done. That's a one. At category three, the gene coding for achondroplastic dwarfism is located on chromosome number... How many people know that? Is that a category one for anyone here? So you're like, I have no idea. You don't want to spend six minutes trying to figure that out, right? So no idea, guess, move on, don't bother coming back. Now that one strategy is when you have no idea, a lot of people say eliminate the extremes and pick something in the middle. So guessing strategies. Look for repetition. Delete the odd man out. So which rotator cuff tendon? This is their example. Which rotator come in... Most commonly torn rotator cuff tendon. The odd man out is the tendon that's not a rotator cuff, but so anyway, get rid of that one and then guess. Category two. So here's a healthy 18-year-old male is brought to the trauma ED with an isolated grade three open femoral shaft fracture. His Glasgow's coma scale is 15. He's moving all extremities. His abdominal exam is benign. His extremities are well perfused. His blood pressure is 80 over 40 and his pulse is 135. His ECG is remarkable, only for tachycardia. The most likely etiology for his hypotension is... Okay, that's not a category one or three. I should be able to figure this out, but it's not a one. So you can sit here and start to narrow your choices. His abdominal exam is benign, all right? So they're telling you right there, it's probably not abdominal. His Glasgow coma scale is normal and he's moving his extremities. So it's not central or spinal cord. So it's not neurogenic. It's not a subdural hematoma. So you can get rid of that. Don't... He's only 18. He's otherwise healthy and his ECG is unremarkable. It's tachycardia. So it's not cardiogenic. So it must be blood loss from his open fracture. So working through it, you know, step by step, you can arrive at the correct answer. Now there are also bad questions. So the key purpose of a question is to differentiate between those. If you're writing questions and you're in charge of the psychometric aspect of developing this instrument, this test, you want the question to differentiate those who are very knowledgeable and capable in this area and those who are not. So if it's a question that no one gets right, that didn't help you, did it? If it's a question that everyone gets right, that didn't help you either. So the people that are writing the test recognize that there are good questions and bad questions. So if very few people get the question right, the high scores and lower scores perform the same on the question, that indicates that people are just guessing and there's no differentiation between the people you want to identify as being very knowledgeable and those who aren't. That question is discarded. A better question is one that the high scores tend to perform better than the low scores. It differentiates and the question is retained. So the point is upwards of maybe even five or even ten percent of the questions may be deemed bad questions and be thrown out. So don't sit there and turn yourself inside out saying this question doesn't make sense. I know this area, but I still don't know. There's a poorly written question and you're getting all stressed out spending all this time on it. It probably is a bad question. It's likely going to be tossed out. So do the best you can and don't get too uptight about it. So recognize that certain questions are eventually torn or discarded. So general tips. Answer the easy questions. Don't revisit. Those are your category ones. Some later questions may help you remember more difficult earlier questions. Go back and revisit your category two questions. Answer all questions. There's no penalty for guessing. Use all the time allotted. Go back to look at your category twos. When guessing between two, often use your first instinctive answer. If an answer seems obvious, it probably is. If two more answers are essentially the same, both would be wrong. If two appear to be correct, choose the one that causes the other to occur. Did you follow that? So the one that causes the initial one, that's probably the one you want to go with. Consider ethnicity, race, gender, age, geography, and occupation when reading case studies. There's a reason why they may put those in there. And again, don't get hung up on what is a bad question because it may be discarded, likely to be tossed. Good luck. Thanks a lot.

test-taking strategies

ABOS subspecialty certification

sports medicine exam

exam requirements

exam makeup

preparation strategies