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Jessica: Hey guys, it's me, Jess. Your host for the Absite Smackdown! podcast. And here with me today is my co-host Dr. David.

Dr. Kashmer: Jessica! We're back again.

Jessica: We are. I mean, did we ever really go anywhere though?

Dr. Kashmer: A couple of places...I've been to Nebraska since the last time we talked. Lots of great emergency general surgery work.

Jessica: Oh, fun, Nebraska. What was that like?

Dr. Kashmer: It was actually really great. I got to visit snow. The people are really nice. The university medical center is fantastic. It was really great. And like you said, here we are again.

Jessica: Yeah. Okay. Well, I'm glad you had fun in Nebraska and doing emergency general surgery. It's probably nice to be back in Florida. Not that it's super warm here right now, not normal for the weather, but it's still Florida.

Dr. Kashmer: Well, Jessica, as you know, it's only about two weeks or so until Absite test time for the 2021 Absite. And I appreciate you having me on again today to talk about some of the more last minute things we can do to prep for that exam.

Jessica: Right. So it is crazy to think that it's so close. And I know that when you were program director, you probably had a plan and goals for your students and what they would be doing week to week to week. So now that it is so close, can you share with us just a little bit of what used to have people doing or maybe yourself, what you do or did...

Dr. Kashmer: Sure. things were very individualized for the residents that I helped coach through their general surgery residency program. We knew whether they were auditory learners. They knew whether they were visual learners or kinesthetic learners where motion is required to help them learn. And different general surgery residents have blends of the different parts. So that was all pre-work done ahead of time. We use the available evidence to kind of know what to do last minute and where they were with their study plan. For example, there's a lot of evidence that the more questions you do, the more likely you are to score higher on the exam. And it's sort of a brute force mentality in a lot of these different studies, just you do a lot of questions and doing a lot of questions is better than not doing a lot of questions, but you know, it doesn't seem to really help as much for long-term retention and kind of mastery of surgery in different ways. But two weeks before the test, you really want to be sure you've done this critical mass of questions and you've seen the breadth and scope of what can be asked and how it can be asked.

Jessica: Okay. So do you feel like just from your personal experience, knowing what kind of learner you are as vital to how you study to get your best Absite score?

Dr. Kashmer: It sure is. it can be tough to do all that really, you know, two weeks before the test. But it is useful to do, I would say long-term, if the people listening to the podcast haven't done that already. There are all sorts of online inventories and other ones you can take to figure out what kind of learner you are. So I totally recommend it. However, two weeks before the test may not be the time to totally revamp your study plan. if you discover what sort of learner you are now, again, many people who've gone through medical school and are in residency know this already, but some of us don't, you know, for example, I didn't. I had an idea for myself, but even I wasn't sure what type of learner I was. Was it a mix? Was it one or the other?

Dr. Kashmer: You know, Jessica, you asked me, what did I do personally before the exam and of course this was back in the day, before the 80 work week, when we drug concrete blocks both ways (uphill) to go to work every day, you know, with people standing on them. And that's a, you know, that's just how it was back then. That's exactly how it was back then. Don't you tell me any differently! Hahaha.

Okay. But two weeks before, two weeks before the exam for me, I would go through the highlights of whatever book I'd used during the year. And I would do as many questions as I could get my hands on. That was my study strategy two weeks or so before the exam.

Jessica: So what...did you do flashcards like old-school?

Dr. Kashmer: You know, I've actually never used flashcards in my life. I tried to use them in medical school a little bit. It just didn't do it for me. But I would just read, I would draw, I would put notes in, and really for me I tend to be an auditory learner and a kinesthetic learner, and that's an unusual combo. But I didn't know that until I'd gone pretty far along. And then after that certain things helped me: listening to different recordings of the facts, whether I made them or not, was really helpful. And, you know, that's part of why Absite Smackdown exists like it does. Yeah, it's an online review course. Yes. The book functions as notes for the online review course, but you can listen to it. You can listen to the podcast version of some of the reviews. You can listen just to the audio portion of the lectures and a large reason why that exists the way it does is because I'm an auditory learner. And I understand it. So when you guys asked me to help put together the course, I realized how valuable it could be for people who are resident staff like I was a resident staff member.

Jessica: I mean, that makes sense.

Jessica: I obviously didn't go to medical school, but I remember my best friend and I-we were in all the same AP classes and I would never open my book. I would just sit there in class and kind of relax and just listen to our professor talk the whole time. And she would be like making notes, she'd be all in her book. And then I would get A's and she would get B's. And she gets so frustrated. 'Cause like you don't even open your book and I'm like, yeah, I listen. And so that's how I learned. And I think that's probably why Absite Smackdown is so awesome and amazing to me.

Dr. Kashmer: Well, that's awesome. And just imagine though if you had a professor whose voice really graded on you or who really just put up pictures or just sort of assigned readings, but didn't tell you all the facts about what you needed for the exam that would sort of make you feel like a stranger in a strange land. And when you have a mismatch between how you study and learn and the professor or the class, that's a real issue. So you can tell that things are often different for different learners, with different styles. And again, Absite Smackdown tries to cater to all those different styles among surgical residents and different people by providing resources in different ways. I can't thank you guys enough for doing that.

Jessica: Oh, no problem. Happy to help. So, all right. So back to the subject at hand or two weeks before you have your study outline, you know, what you should be doing, where you're at, how you're prepping, what you're doing, and then, you know, what do you think in your opinion is the most important thing besides, like you said, just going through the questions, questions, questions. Is there anything else that they can do to make sure that they're ready?

Dr. Kashmer: Sure. There are a couple things, first, where do you get the questions? I think we should answer that in the podcast and there are several resources. There is a True Learn, which has a great Absite section, including a diagnostic test. So whether your residency gets that for you or you get it yourself, I fully recommend getting that in addition to things like the SCORE curriculum.

Dr. Kashmer: The second item I'd recommend is making sure you've reviewed your highlights and your notes. I can't say enough about that. And Absite Smackdown does have some questions associated with each module and we're actually going to be fleshing that out with the next version. So two weeks before the exam to make sure you're ready, a lot of it comes down to questions and then we have some other options you guys have helped provide to myself and other faculty.

And there's a performance curve. There's an association between performance and being sort of keyed up or even anxious. And if you get past a certain point, you're too keyed up. So I've found, interesting options like the coloring book and the crossword puzzle book that you guys, have helped, put out are really awesome. They can help relax you and help you study. So shameless plug, I just got my author copy from you guys. There it is right there. That's the crossword puzzle book. I have the coloring book too, but that's in another room and I'll just tell you, it's great because it relaxes you a little bit, but you're still doing a little work and it's kind of a nice option to cap things off at the end. So...shameless plug. Yeah, but you want to make sure you're not too keyed up before you take the exam so that you get the best score report you can from this examination!

Jessica: But it really is a good idea, especially the crossword. Like you have to know that information. I was of course obviously looking at it and going through and I felt like I knew it, but then I went to do the crossword and I'm like, "Oh, okay. I know this, I know this." And it really makes you think about it and go back into your brain. And so I just, I felt like that was excellent. I got so much from that trying to do the crossword versus just everyday when I go down through the book or almost into things, those are great, but it really made me think, trying to do that crossword, which was excellent. So yeah.

Jessica: It is fun. So I fully support that plug. All right. So plowing through the practice questions, getting as many done as you can, your resources, where you find the questions and so between those things, and then obviously just the little examples you've given, like doing the crossword or anything, and if people are old school and want to do flashcards, maybe that works for someone I'm not sure. Is there anything else that you think that people could be doing for this examination? They should know what learning style they have right now, but can you give an example maybe for each learning style, what would be a good resource for them to use?

Dr. Kashmer: Sure. The kinesthetic one is really challenging. I've seen people do everything from making up a dance for the certain facts to everything in between. So I'm going to put kinesthetic aside because it's tough. It's important in the OR for muscle memory, but it's tough for facts. I would say for the auditory stuff, you can record yourself saying different things or different facts. You can also review by listening to the Absite Smackdown portion of lectures or the podcasts, which is another good option for the podcasts that are straight review, those episodes we've done. And for the visual, the pictures, whether that's, with Absite Smackdown or something similar, you can review the visuals on it, the high yield images, from your review book, and your notes even can really help visual learners. So there are certain key things for each style and the lectures with the audio that we provide or that of course provides really hits several of those learning styles at once. Again, we're going to put kinesthetic aside for a second, because that is a very challenging one. I would say if you can make up something or associate something with a physical movement that seems to help, but that is a very difficult one.

Jessica: Right. Do you think drawing goes into that though when you're drawing out the organs and drawing out the procedure, and is coloring sort of similar with that?

Dr. Kashmer: It can. And also writing your notes out or copying your notes for the muscle memory. That helps people to remember. Also any opportunity to study in the same space you will take the exam...but it's often hard for residents to know where they'll be taking the exam. The ability to do that also can help kinesthetic learners to be in a familiar situation or the one where they're going to take the exam. There are a lot of different options.

Jessica: I'm just so sad. I've never seen someone dance in the OR, like what. Like why, why haven't I seen that?

Okay. So let's just go back and review really quick. So again, two weeks before what everyone should be doing, getting through the questions...there's 250 questions in the test. So as many questions as you can go through to hit and touch base on that's the best. And then again, where you find those questions be it outside of Absite Smackdown, or Truly? Is that what you said?

Dr. Kashmer: It's called True Learn. Yeah. True learn is one of the question bank options online that includes a diagnostic test for the Absite. It's a very valuable resource and I really recommend it as a source for simulated Absite questions.

Jessica: Okay, perfect. So that, and then depending on your learning style, how you helped yourself study from flashcards, dancing, writing your notes, turning your notes into dictation and the re-listening to them...so many options on what we can do any last minute! Any final words of advice from you, Dr. David, to help absite performance?

Dr. Kashmer: Just remember the goal is to have yourself peak in terms of knowledge and Absite performance around test time and keep in mind that famous curve of performance. I think it's called like the Yerks-Dodson curve to have the fancy name, but it's sort of the performance curve and a certain amount of anxiety is associated with peak performance in examinees. But when we get too anxious...if you're too revved up, you will fall off the other side of the curve even as a surgery resident. So remember your goal is to have everything peak right around the Absite time, right in the next two weeks at the end of January. We've talked about other things like taking vacation in January gives you time and a little relaxation, but the cat's out of the bag for options like that for you as a test taker this year on the Absite exam. Just keep that in mind for next year. So remember the goal is to peak right at the end of January. And there are lots of ways to do that. And even to relax and still do a little studying with the Absite Smackdown crossword puzzle book, or the coloring book, and that's sort of what those options are for.

Jessica: Right. And remember plenty of sleep before test time, don't take call the night before. And what else did you learn personally from your Absite days NOT to do right before the test?

Dr. Kashmer: Well, there are so many things, but the sleep is a key. The sleep is key and I'm glad you brought it up. Plenty of studies on that. Now, the call schedule is probably made for the month. But if you can go ahead and get that rest ahead of time or have any option to do that make sure you do it. It does seem to impact performance on the Absite in many of the different series. And I'll tell you having fallen asleep in an Absite before several times (with that kind of microsleep stuff) I can't agree with it more!

Jessica: Oh gosh. Okay. So all of our listeners out there, hopefully you get plenty of sleep! Don't microsleep during the test. Study whichever way helps you best. And again, if you have any questions, you can always email us at our email address: info@thehealthcarelab.org. And thanks for being with us! Have a great weekend week and #AbsiteSmackdown!