Absite Smackdown! · Episode 45: What To Do Two Months Before The Test



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Jessica: Hey guys. Welcome back. It's Jessica, your host of Absite Smackdown podcast. And here with me is Dr. David Kashmer. Hey Dr. David!


Dr. Kashmer: Jessica. Good to be back with you today.


Jessica: Thanks for coming in. So I'm pretty excited because it is mid-November, which means we're six to eight weeks out from the Absite test.


Dr. Kashmer: Yeah, it's that time of year again. And I'll tell you, it comes up on you quickly every year. It's about the same time each year, but every year it sure feels like it's on you almost before you know it!  Our program used to give the Absite January 28th or so.


Jessica: Well, I think people just need to think holiday time means study time.


Dr. Kashmer: Yeah. Every holiday time seems to be study time because you have some time off. And then when you do you sit there and you say, “Oh, I should probably read something now!” But you're right. It's especially this time of year where it's holiday time and it's study time.


Jessica: Alright. Well, because it's six to eight weeks out, I feel like you're kind of the perfect person to go into what everyone should be doing. since you are a former resident director.  I think that would be really helpful if you shared with us what you would usually have your residents do about this time.


Dr. Kashmer: Well, like you said, yes I was a program director and one of the key things that we focused on was lifelong learning.  Meaning, although Absite preparation is key. We really want to build people who are going to leave the program and continue to learn for the rest of their lives. And that means working into the busy everyday schedule of surgery the ability to study new things that come out all the time. In fact, there's an old saying that as soon as the textbook comes out, it's about four years out of date because that's kind of the germination period for a textbook to get done and get out there to the public for consumption. So one of the things we do is we make it an everyday event to study. And part of that is Absite study. We look at the test as something that we do take time to train for specifically, but it's part of an overall package where we're building lifelong learners. Does that make sense?


Jessica: Makes complete sense. It kind of reminds me of cell phones when she gets a new thing it's already old again, and they're releasing something else.


Dr. Kashmer: That's exactly how it is. So let me share with you. That's also part of why, as you all helped me as the publishers of Absite Smackdown!, we update it every year. We tweak the content. We tweak the format and that's because kind of life and Medicine rush on all the time. You know, the Absite is really a test of a lot of the tried and true surgical aphorisms or wise sayings or things that don't really change much because even though there are new techniques, and there is the revision of how we think of old techniques, the Absite really focuses on core General Surgery knowledge to assess originally how well the program is doing to educate resident staff. And then later on, it became much more than that. And now it’s almost a referendum on the residents and what they're learning rather than kind of its initial intent, which was to get a sense of how well the program is educating them.


Jessica: Well, speaking of that, is it important how the program affects the residents score?


Dr. Kashmer: It is.  You know, in another podcast we talked about key program factors that seem to affect a resident's scores and as a program director, I really felt like, you're sort of the coach of a team and your program develops a future colleagues.  It's as much a function of the program as it is the individual learner for how they perform on the Absite. And, you know, you also asked what did you have the staff doing six weeks ahead of time?  And I got kind of broad with it and talked about lifelong learning, but I'm going to tell you specifically on our monthly reading list, we synched up a certain topic with reading across multiple books and these included famous books like Cameron, Schwartz, sometimes even Greenfield (a book that's out of print) called Complications In Surgery.


We had a series of books that we went through. So one month would be hepatobiliary month and it would be all about HPB across those books. So six weeks ahead of Absite time, we would sort of concentrate on familiarizing the residents with the computer interface for the test. What does it look like and what does it feel like?  And in the book, the Absite Smackdown!, we have a link to the sample interface put out by the American Board of Surgery online. So people can get a feel for that. We had them look at the content and what it is and where it came from. So they kind of know what to study and what sections have more of a focus than others. And so this was in about the six to eight week mark before the test.  We'd sort of say:  “Hey, let's get familiar with test specifics and mechanics.”


You know, they're about 250 questions. There are some “test” questions, meaning ones that are being evaluated, and it will be sometimes hard to tell which those are.  So don't really stress about it. We'd also talk with them about how the difference in score percentile between one person's percentile versus another can come down to really very few questions. The curve is very steep for the Absite. A couple of questions more will propel you to a much higher score which is fascinating.


And last but not least, we'll teach things like a score of 30% or beneath in any year of residency puts you at a higher risk for failing boards. And we did a blog entry about this too, but it doesn't mean you'll fail boards. You're actually still more likely to pass boards than you are to fail boards. Even if you had a 30% percentile score or lower.  So about the six week mark, we focused on a mechanics of the tests specifically.  And that's in Absite Smackdown! that we share most of those links so that you can get a sense of, or users can get a sense of, exactly how the test works when it's given and what the mechanics are.


Jessica: Really that’s the first couple of chapters in the book.


Dr. Kashmer: Yes the beginning of the book sort of talks about why I really wanted to share this with everybody. And then not long after, just like you said, is what are the specific mechanics of the Absite.  Those sure did help me.


Jessica: Hmm, wonderful. Okay. So six weeks before with your residents you're going over the broad strokes about 250 questions, everything and how it applies and then what what's next?


Dr. Kashmer: Well, it really somewhat depends on the resident. Some residents had a performance of less than 30% in a prior year and they have more of a defined study plan that we've talked about and gone over to help them with their strengths, and, you know, kind of smooth over any weaknesses that they had on a previous test. But another thing is that we try to get residents to understand some of the things that seem in studies to propel people to a better score. So we try to coach them to get the best score and demonstrate the best level of knowledge that we know they have. So some of those include a focus on questions. It turns out that there's a lot of studies and we cover these in another podcast about doing some questions, that indicate doing a lot of questions is better than less.


Dr. Kashmer: It's sort of a brute force approach.  You need to be careful with this because you can do a whole lot of questions and you'll do better than somebody who didn't do questions, but will you really have mastered the material?  You'll have mastered answering questions and some others. So to kind of really get at that deep learning, we encourage the use of some core review material. And then on top of that, and it has to be in the study plan, the plan to do a lot of questions because statistically significantly it seems to correlate with performance. So we have to make time to do questions.


Jessica: Okay. So nowadays, the residents have all these mediums:  they have our book, all these other study guides, our online course…When you were a resident studying for this, what did you do?  Give us some of your experience?


Dr. Kashmer: I read.  I read all the time.  Every day--and I don't just say that.  It was all the time and one of the things I did every day.  After I would read a section about something from a textbook, I would do an Absite review portion of it. I didn't have all the tools that I wish I did.  We had some of the kind of bullet reviews or notebook or outline reviews that are still around. I actually knew two of the people who wrote two of the more well-known books. And, I thought that there were some things that I wish they had. And then one day I really wanted to share. And that's what started this.  So at the end of reading a section, as I went along, I would always read an Absite review book portion on the same thing. And it also helped me with stuff that I didn't get from the textbook or that I missed or that I didn't realize was important. So it was blended into what I did every day, all year long.


Then around Absite time I would start doing questions. There are several question banks. There are several well-known ones today.  And those were really useful. There were some books of questions that we had, but now they're online.  Whole data banks of questions—and you really just have to use them. They're fantastic. One offers you a self-assessment, like a sample test you can take, also. You can use that to kind of help guide your study, but you have to do questions.  Why did I do all this?  Well, it really helped me focus.  My first time around with the Absite, whether it was because I was on call the night before and kind of fell asleep during it, or whether it was because I hadn’t studied enough (or both) my performance on that first time around was not what I wanted it to be.  I really wanted to do better.


And that's what started me down the pathway for subsequent years.


Jessica: Well, thank you so much for sharing that with us today! I'm excited for week five, week four week, week three. So I can't wait till we meet with you next time. Thank you for helping everybody and doing this podcast today. And again, guys, just remember we are six weeks to two months out!  What should you be doing Dr. David?!


Dr. Kashmer: Questions, questions, questions all the way along and also about this time, learn the mechanics of the test so that you're prepped and you've minimized any surprises for how the test runs on test day.


Jessica: Perfect. All right, guys. Thanks for joining us. And again, remember:  #AbsiteSmackdown!

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