It has been demonstrated that there are three primary types of guessing: random, cued, and informed (2). Random guessing occurs when examinees respond in a completely blind manner with no insight whatsoever to the best answer. Cued guessing occurs when a response is based on a stimulus in the prompt. Informed guessing is often referred to as an “educated guess” and occurs when the response is based on partial knowledge.

Medical examinees rarely result to random guessing, but often make decisions based on cued or informed guesses (3). An important test-taking strategy is to remove responses that are thought to be incorrect. By simply removing these wrong options, the examinee increases one’s chances of answering an item correctly. However, if one is able to eliminate all but two response options, one still has, at best, a 50% random chance of answering correctly.

ABIM officials have been reported as stating that nearly 85% of the test questions are presented as clinical scenarios rather than remote knowledge-based facts. Twenty-two percent of the questions recite material from previous exams, and most questions emphasize general knowledge. It is rare for a highly up-to-date material to be tested since these questions are compiled more than a year prior to the examination date. Certainly, late-breaking clinical studies will not be tested.

The ASCeXAM is now provided at computer testing centers. Multiple-choice and case-based questions are included. At the time this review book was written, the content outline stated that the ASCeXAM will consist of a total of four testing blocks: three multiple-choice blocks (60 minutes) and one case-oriented block (90 minutes). The questions will be categorized as being obtained from one of the following categories:

Examinees will be tested on knowledge of M-mode, 2D and Doppler echocardiography, TEE, contrast, and stress echocardiography.

“Cramming” data in for a couple days prior to the ASCeXAM may cause retroactive inhibition. This is the phenomenon in which longer-term “knowledge” is replaced by short-term “memory.” Since it is unlikely that one can add enough short-term facts to offset the loss of long-term knowledge, this
becomes a poor trade-off. Despite that fact, however, some successful examinees have used the few days before an exam to memorize material that they have found to be difficult to learn. This includes equations or quantitative parameters that are likely to be needed. For example, some test takers may be weak in physics and will memorize equations for wavelength, bandwidth, attenuation coefficient, Doppler shift, etc.

Others may memorize the mild and severe categories of quantitative valve regurgitation (all else is moderate) and be able to write these down on scrap paper once the test starts. Doing so prior to looking at the first question will provide the examinee with his or her own table to use when these values are called upon. Doing a quick “mind dump” of information you do not want to forget is valuable and should be practiced for accuracy prior to the exam. Repetition is important.

The most important test-taking strategy we can offer is to “anticram.” If cramming is the art of spending hours nonstop studying for days (or even weeks) prior to the examination, then anticramming is practicing test taking in the first year of your fellowship. Adult cardiovascular fellowship programs that incorporate practice questions on a weekly basis are more likely to have well-prepared graduates that will succeed in passing their certifying exams on the first attempt. Creating a culture of practice exams and having trainees actively answer board-type questions fulfill one of the most important tenets of test-taking skills: practice, practice, practice! Although “practice may not make perfect,” it will create a level of confidence that reduces the memory-taxing anxiety component for many examinees. Importantly, this practice helps to provide a structured format to identify weak areas requiring additional study. Take notes during your conferences and practice sessions.

Some past ASCeXAM diplomats have found that “small study groups” were highly rewarding. Even though this practice may have been new to the examinee, the highly specialized knowledge required for this exam tended to benefit from small group discussions. According to the individuals who benefited from this practice, it seems that regular consistent meetings (usually weekly) were most valuable. Limiting the groups to only those three to six fellows actually taking the next echo boards kept the discussion focused. If other fellows wanted to “get a leg up” and attend, they were asked to take notes and learn, but not interfere by talking or asking many questions. In 4 to 6 months, a small group setting can cover an entire textbook. At each 45- to 90-minute review session, some of the time should be dedicated for practice questions. Keep notes during your review sessions and record frequently poorly understood concepts and disease or technical categories for additional focused study.

Most of the fellows and faculty we spoke with highly recommend the ASE review and Mayo Review courses as a means to review material, to add confidence to current knowledge, and to fill in the remaining gaps of knowledge. In our opinion, these review courses are useful toward the end of the study period, but would not make up for 4 to 6 months of paced study.

When using this Review Book and other sample questions, it is most important to study the incorrect choices as well as understanding why an answer was correct. Simply answering a question correct is not nearly as valuable as carefully understanding why the other options were incorrect. At times, you may answer a question correct without sufficiently understanding the material. Moving on in this circumstance would subject the examinee to missing this same (or similar) question in the future. However, taking the time to study the other options and moving on only after truly understanding the educational teaching point(s) will go a long way to adding to your knowledge base and preparing you for a future similar question. For this reason, our book was designed to have extensive discussion after each question to provide the necessary material for knowledge growth.

Board-type questions contain initial prompts or stems. These are often clinical based. The examinee who performs well is often able to “pick out” pertinent details and create his or her own answer prior to looking at the options offered. Although there are no trick questions, it is important to remember that just like patients, partially correct answers are common, and therefore the entire sentence in each of the answers should be read prior to selecting your final answer.

In answering long questions, especially when extensive clinical details are provided (occasionally as red herrings), it is always worthwhile to review the last sentence of the stem and selected options initially so as to assist you in picking out important facts when reading through the lengthy prompt. This focuses your attention on the critical portions of the written material. This “tip” is equivalent to hearing a lengthy case history on consultation rounds and at the end of the presentation, learning the reason for the consult. You are better off knowing the reason for the consultation request at the beginning of the presentation, which allows the expert consultant the opportunity to “filter” the relevant from the unnecessary information being presented. With this approach, the best answer may be obvious prior to reading the entire prompt. Over the course of a multihour examination, this practice reduces the common ailments of mental and eye fatigue. See example.

Always eat before your exam. Avoid heavy foods, which may make you groggy. Apples enhance memory recall more than coffee, but consistency is most important. If your practice study sessions involved coffee, then coffee it is. However, you should neither start drinking nor stop drinking coffee (or eating apples) just for the exam.

It is always important to look for the central idea of each question. What is the main point? Most question writers have a single teaching point they want to emphasize, and if you are able to identify this, then the answer may become more visible. Avoid the temptation to read too much into the question and make it harder than it was intended to be.