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7/28/2014
1
Test-Taking Skills
Written
Donald Sefcik, DO, MBA, FACOFP
Disclosure
Why are Standardized Tests so hard?
Faculty-generated tests Standardized tests
7/28/2014
2
Introductory Comments
• Do you know someone that:
– Studied LESS and scored HIGHER than you?
What’s the impact of study hours COMLEX Level 1 exam
Hours Studied <100 101-150 151-200 201-250 251-300 301-350 351-400 >400
Mean Score 552.75 533.50 536.17 530.43 545.95 549.85 523.00 536.25
538.2 538.8
MUSCOM Research; AACOM 2012
Hours <100 101-150 151-200 201-250 251-300 301-350 351-400 >400
Maximum 599 539 581 657 778 717 679 692
Minimum 480 528 428 428 415 382 397 367
Range 119 11 153 229 338 311 330 325
What the C1 mean doesn’t tell us
128 326
MUSCOM Research; AACOM 2012
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Higher Scorers
_
X
???
Neural Plasticity
Study
Techniques
Study
Techniques
Higher Scorers
_
X
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Overall View
“Have to…”
“Get to…”
Highest Scorers
Lowest Scorers
Study Techniques / Resources
Efficient
Effective
Highest Scorers
Lowest Scorers
Majority of Effort
Preparation
Exam Day
Highest Scorers
Lowest Scorers
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Skill Development
Test-
Wiseness
Test-
Taking
Highest Scorers
Lowest Scorers
Maximizing your SCORE
Test-Wiseness Test-Taking Skills
• Reading Accuracy
• Reading Fluency
• Guessing
• Changing Answers
• Test Blueprint
• Long-term Memory
• Transfer
• Self-Regulation
TEST
ANXIETY
Maximizing your SCORE
EXAM DAY
• Reading Accuracy
• Reading Fluency
• Guessing
• Changing Answers
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Example
Infarction of the right ventricle occurs when the proximal
segment of the right coronary artery is occluded. Which of the
following is the most sensitive electrocardiographic (EKG)
finding of a right ventricular infarction?
A. ST segment elevation in I, aVL, V5 and V6
B. ST segment depression in V1, V2 and V3
C. ST segment elevation in V1, V2 and V3 with
ST segment depression in aVF
D. ST segment elevation in V4R with an upright T wave
E. ST segment elevation in V1 (> 2.5 mm) with a
right bundle-branch block
Example
Infarction of the right ventricle occurs when the proximal
segment of the right coronary artery is occluded. Which of the
following is the most sensitive electrocardiographic (EKG)
finding of a right ventricular infarction?
A. ST segment elevation in I, aVL, V5 and V6
B. ST segment depression in V1, V2 and V3
C. ST segment elevation in V1, V2 and V3 with
ST segment depression in aVF
D. ST segment elevation in V4R with an upright T wave
E. ST segment elevation in V1 (> 2.5 mm) with a
right bundle-branch block
STEM
OPTIONS
Example
Which of the
following is the most sensitive electrocardiographic (EKG)
finding of a right ventricular infarction?
A. ST segment elevation in I, aVL, V5 and V6
B. ST segment depression in V1, V2 and V3
C. ST segment elevation in V1, V2 and V3 with
ST segment depression in aVF
D. ST segment elevation in V4R with an upright T wave
E. ST segment elevation in V1 (> 2.5 mm) with a
right bundle-branch block
Interrogatory
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Example
Infarction of the right ventricle occurs when the proximal
segment of the right coronary artery is occluded. Which of the
following is the most sensitive electrocardiographic (EKG)
finding of a right ventricular infarction?
A. ST segment elevation in I, aVL, V5 and V6
B. ST segment depression in V1, V2 and V3
C. ST segment elevation in V1, V2 and V3 with
ST segment depression in aVF
D. ST segment elevation in V4R with an upright T wave
E. ST segment elevation in V1 (> 2.5 mm) with a
right bundle-branch block
Interrogatory
Distractors
Impact of Stem (Vignette)
Examinees with
Higher Scores
Examinees with
Lower Scores
No Vignette 99% 90%
Short Vignette 98% 82%
Long Vignette 98% 66%
http://www.nbme.org/pdf/itemwriting_2003/2003iwgwhole.pdf
Examinees with
Higher Scores
Examinees with
Lower Scores
No Vignette 99% 90%
Short Vignette 98% 82%
Long Vignette 98% 66%
Reading
A patient with hyponatremia and highly concentrated urine is noted
on CXR to have a centrally-located, suspicious-appearing, solitary
pulmonary nodule. Which of the following is the most likely explanation?
A. small cell carcinoma
B. squamous cell carcinoma
C. adenocarcinoma
D. large cell carcinoma
E. mesothelioma
EXAMPLE
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Pulmonary Masses Apical
TB
Peripheral
Large Cell Carcinoma
Adenocarcinoma Central
Small Cell Carcinoma
Squamous Cell Carcinoma
Pleural-Based
Mesothelioma
A patient with hyponatremia and highly concentrated urine is noted
on CXR to have a centrally-located, suspicious-appearing, solitary
pulmonary nodule. Which of the following is the most likely explanation?
A. small cell carcinoma (central)
B. squamous cell carcinoma (central)
C. adenocarcinoma (peripheral)
D. large cell carcinoma (peripheral)
E. mesothelioma (pleural-based)
EXAMPLE
SIADH
Reading Accuracy
Exam Day
Performance
• Selecting Answers
Know for Sure (Record & Confirm Choice)
Familiar but Not Sure (Maximize Probability)
No Idea (Test-Taking Skills; Guessing Better)
• Changing Answers
• Reducing Test Anxiety (Exam Site Issues)
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• Focus on the Stem – Find the BEST answer
– If you know if after reading the stem, “go for it”
• Read ALL options before recording answer – Avoid partly correct responses
• Go with instinctive (GUT) feeling – You picked it for a reason
• Once decide incorrect – Do not consider it again
• Avoid “reading into” the question – The stem sets the task
During the Examination
Question
What probable etiologies are suggested when drugges foss
in extremis?
A. Sloorgs thanceed with the droxemia
B. Potcoms fotted secondary to an oral deficiency
C. The dagts ptopted and the frodds roanzed
D. The dhiths buazzed secondary to gastrointestinal crooleets
E. Taggoks were removed from the juklets
Question
Patients suffering from strugleum frequently undertrosl the gruifreit
because:
A. all patients with strugleum have krodncurz.
B. strugleum always presents with qugruestful.
C. there are never cases of strugleum without feskabolose.
D. patients with strugleum commonly have gizzlehorst.
E. no fuegrools results in strugleum.
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Question
Along the eastern coast of Maine, the cases of huestoolduds are
most often secondary to:
A. poor nutrition.
B. the moisture in the frocklesters.
C. the abundance of greezles.
D. a relative abundance of kleasternezers.
E. an oversupply of fhoulsteens that occur directly as a result of
kjuoost, djurts and bhespernets maldoorneys.
Question
The drug of choice for patients experiencing
zhiglerastasis secondary to kweatlostosis is:
A. dragrootmycine.
B. brusterocilline.
C. noopkweetosporine.
D. zhiglerpurocine.
E. pneustodregcycline.
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When GUESSING is the ONLY alternative
General Alternative
If four of the five options are very specific and one is
very general…
Often the more general option is correct response
During the Examination
When GUESSING is the ONLY alternative
Longest Alternative
Often the exam writer wants to be sure you have
enough information to recognize the correct
Response.
During the Examination
Chase 1964
During the Examination
When GUESSING is the ONLY alternative
Longest Alternative
Question
Along the eastern coast of Maine, the cases of huestoolduds are
most often secondary to:
A. poor nutrition.
B. the moisture in the frocklesters.
C. the abundance of greezles.
D. a relative abundance of kleasternezers.
E. an oversupply of fhoulsteens that occur directly as a result of
kjuoost, djurts and bhespernets maldoorneys.
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When GUESSING is the ONLY alternative
Grammar Agreement The stem and responses should be grammatically
correct…
Singular stem should not be completed by plural
option
During the Examination
Broad & Whitney 1972
During the Examination
When GUESSING is the ONLY alternative
Grammar Agreement
Question
What probable etiologies are suggested when drugges foss
in extremis?
A. Sloorgs thanceed with the droxemia
B. Potcoms fotted secondary to an oral deficiency
C. The dagts ptopted and the frodds roanzed
D. The dhiths buazzed secondary to gastrointestinal crooleets
E. Taggoks were removed from the juklets
When GUESSING is the ONLY alternative
Specific Determiners The implication of absoluteness (always, never,
must, none, only…) is often incorrect.
Words that permit exception (seldom, usually, often,
perhaps, etc.) are more commonly associated with
the correct response.
During the Examination
Milman 1965
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During the Examination
When GUESSING is the ONLY alternative
Specific Determiners
Question
Patients suffering from strugleum frequently undertrosl the gruifreit
because:
A. all patients with strugleum have krodncurz.
B. strugleum always presents with qugruestful.
C. there are never cases of strugleum without feskabolose.
D. patients with strugleum commonly have gizzlehorst.
E. no fuegrools results in strugleum.
When GUESSING is the ONLY alternative
Clang Association Similarity between a word in the stem and correct
response.
During the Examination
Diamond & Evans 1972
During the Examination
When GUESSING is the ONLY alternative
Clang Association
Question
The drug of choice for patients experiencing
zhiglerastasis secondary to kweatlostosis is:
A. dragrootmycine.
B. brusterocilline.
C. noopkweetosporine.
D. zhiglerpurocine.
E. pneustodregcycline.
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When GUESSING is the ONLY alternative
Deductive Approach (Convergence) A. W & X
B. Y & Z
C. X & Y
D. V & Z
E. X & Z
During the Examination
Smith 1982
When GUESSING is the ONLY alternative
Deductive Approach (Convergence) A. W & X V = 1
B. Y & Z W = 1
C. X & Y X = 3
D. V & Z Y = 2
E. X & Z Z = 3
During the Examination
Smith 1982
A patient with a history of angina and syncope is noted to have
a systolic murmur. Which one of the following sets of findings
distinguishes chronic mitral regurgitation from other etiologies?
A. Laterally displaced PMI, normal S2, murmur intensity decreases with Valsalva
B. Normal PMI, split S2, murmur is loudest during midsystole
C. Laterally displaced PMI, normal S2, murmur is loudest during late systole
D. Sustained PMI (heave), normal S2, murmur radiates to apex
E. Laterally displaced PMI, split S2, murmur intensity decreases with Valsalva
Deductive Approach
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A patient with a history of angina and syncope is noted to have
a systolic murmur. Which one of the following sets of findings
distinguishes chronic mitral regurgitation from other etiologies?
A. Laterally displaced PMI, normal S2, murmur intensity decreases with Valsalva
B. Normal PMI, split S2, murmur is loudest during midsystole
C. Laterally displaced PMI, normal S2, murmur is loudest during late systole
D. Sustained PMI (heave), normal S2, murmur radiates to apex
E. Laterally displaced PMI, split S2, murmur intensity decreases with Valsalva
Deductive Approach
Guessing Strategies
• Changing Answers….
– 1/5 = What is percent chance right?
– If first guess = 20% (1/5)
– Second guess = 25% (1/4)
– BUT - If right and change it, now 100% wrong!
7/28/2014
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Maximizing your SCORE
Test-Wiseness Test-Taking Skills
• Reading Accuracy
• Reading Fluency
• Guessing
• Changing Answers
• Test Blueprint
• Long-term Memory
• Transfer
• Self-Regulation
TEST
ANXIETY
Research indicates:
Optimal amount of stress (maximizes performance)
Yerkes-Dodson Law 1908
High
Performance Test Anxiety
Low
Low Stress High
Test Anxiety
Can Cause
• Psychological Changes – GI Symptoms, Insomnia, Headaches
• Emotional Changes – Irritability, Moodiness, Frustration, Anger
• Cognitive Changes – Memory Blocks, Attention Span Limitations
Test Anxiety
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Caused by
• Lack of Preparation – Cramming
– Procrastination
– Poor Study Habits
• Recurring Thoughts
– During the exam
– BEFORE the exam
Test Anxiety
Ways to Reduce
• Plan Studying & Improve Study Skills
• Understand the Examination – Test Blueprint (Table of Specifications)
– Pilot Items
• Build Confidence – Study effectively & efficiently
Test Anxiety
Maximizing your SCORE
Test-Wiseness Test-Taking Skills
• Test Blueprint
• Long-term Memory
• Transfer
• Self-Regulation
7/28/2014
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Plan
Activity (a verb not a noun)
• Select Topics (AOBFP Exam Blueprint)
• When to Study (Metacognition & Self-Regulation)
• How to Study (Long-Term Memory & Transfer)
• Ways to Reduce Test Anxiety (Pilot Items)
PLANNING
for
Standardized
Tests
Scoring
Content
Skills
Timed
Guessing
Items
Standardized Tests - PLANNING
Test-Wise Test-Takers: First Step in Planning
7/28/2014
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Blueprint – Why Important?
Exam Content %
Addiction Medicine 3
Adolescent Medicine 4
Behavioral Sciences 12
General Medicine 48
Geriatrics 5
Surgery 13
Obstetrics / Gynecology 4
Pediatrics 4
Sports Medicine 3
Women’s Issues 4
http://www.aobfp.org/cert-req/cert-app.html
Blueprint – Distribution of Items
Exam Content %
Addiction Medicine 3
Adolescent Medicine 4
Behavioral Sciences 12 Weighting
General Medicine 48 Weighting
Geriatrics 5
Surgery 13 Weighting
Obstetrics / Gynecology 4
Pediatrics 4
Sports Medicine 3
Women’s Issues 4
http://www.aobfp.org/cert-req/cert-app.html
Breakdown by Discipline
General Medicine 48%
Allergy / Immunology / Rheumatology 5
Cardiology 5
Dermatology 5
Endocrinology 5
Gastroenterology 5
Hematology 4
Nephrology / Urology 4
Neurology 5
OPP 5
Pulmonology 5
http://www.aobfp.org/cert-req/cert-app.html
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http://www.aobfp.org/cert-req/cert-app.html
Behavioral Sciences 12%
Preventive Medicine 5
Psychiatry 4
Medical Jurisprudence 3
Breakdown by Discipline
http://www.aobfp.org/cert-req/cert-app.html
Surgery 13%
EENT 5
General Surgery 3
Orthopedics 5
Breakdown by Discipline
Blueprint – Guides Study Order
Exam Content % Interest
Addiction Medicine 3
Adolescent Medicine 4
Behavioral Sciences 12
General Medicine 48
Geriatrics 5
Surgery 13
Obstetrics / Gynecology 4
Pediatrics 4
Sports Medicine 3
Women’s Issues 4
http://www.aobfp.org/cert-req/cert-app.html
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Blueprint – Be Mindful of Priorities
Exam Content %
Addiction Medicine 3
Adolescent Medicine 4
Behavioral Sciences 12
General Medicine 48 DS #10
Geriatrics 5
Surgery 13
Obstetrics / Gynecology 4 DS #1
Pediatrics 4
Sports Medicine 3
Women’s Issues 4
INVERSE of INTEREST
Ways to Enhance
MEMORY
Information
Storage
Retrieval
Recognition Recall
Information IN
Storage
Study Habits
Learning Style
Organization
Retrieval
Associations
Understanding
Cues
Information OUT
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Retrieval
Recognition Recall
Less Active
Factual
Cues Present
Repetition
Cramming
More Active
Problem Solving
Cue Absent
Bridges
Strategies
Ways to Enhance the Process
Remembering Transfer
30% 70%
PLANNING
for
Standardized
Tests
Scoring
Content
Skills
Timed
Guessing
Items
Standardized Tests - PLANNING
Pilot Items
1. Can’t identify them
2. Don’t count
3. Capitalize on presence
Preparation
PRACTICE
• Study Techniques (Clinical Vignettes)
Study Aids (Which Resources to Use)
Study Behaviors (Reading; Q&A Activities)
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Preparation
Improving Performance
Content Context (Information) (Abilities and Attitude)
Study Aids Study Behaviors
• Total-Time Hypothesis
Reading next day (Distributive Trials) • Reduces time required to “relearn it”
• Increase memory
Time Management
Ebbinghaus 1880; Medina 2008
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• Escape Syndrome
– Sitting around thinking about/talking about
“how bad it’s going to be”…
Time Management
• Understand & Associate (Meaning)
– Meaningless Facts memorized
• Day 5 = Recall ~ 40%
• Day 30 Recall < 10%
– Principles Understood with Meaning
• Day 5 = Recall > 95%
• Day 30 Recall > 90%
Self-Directed Learning Methods
Maddox 1964; Medina 2008
Self-Directed Learning Methods
• Develop a Strategy
– Choose strategy to meet your needs
Reading
• 50% of time should be spent reflecting
• Additional Suggestions
– Paraphrasing (increase understanding)
– Retrieval (create notes from memory)
McWhorter 1998
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• Self-Evaluation
– Be sure “Closing the Gap”
• Question-and-Answer Resources
–Maximize potential
Self-Directed Learning Methods
Impact of Stem (Vignette)
Examinees with
Higher Scores
Examinees with
Lower Scores
No Vignette 99% 90%
Short Vignette 98% 82%
Long Vignette 98% 66%
http://www.nbme.org/pdf/itemwriting_2003/2003iwgwhole.pdf
Examinees with
Higher Scores
Examinees with
Lower Scores
No Vignette 99% 90%
Short Vignette 98% 82%
Long Vignette 98% 66%
Q&A resources
• Fluency
– Practice reading faster
– 10 minutes = 10 items; 60 minutes = 60 items
– Do not look up any answers until finished!
– Better if global not by topic / content
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Q&A resources
• Fluency
– What else do we know about reading?
– When the answer is not readily apparent…
– Lower scorers: stem-options-stem-options
– Higher scorers: stem-stem-stem…
Q&A resources
• Accuracy
– Feedback is critical to your success!
– Read explanations before you score yourself
– When you calculate your score, break it down
Q&A resources
• Accuracy
– Break your score into component parts
– 1. A*
– 2. C^
– 3. D#
A* = I know this
C^ = I have some familiarity with this
D# = I have no idea
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Q&A resources
• Accuracy
– Feedback
– Overall score = 47/60 (78%)
– BUT…
* = 11/20 (55%)
^ = 17/20 (85%)
# = 19/20 (95%)
This is a problem!
Q&A resources
• Accuracy
– Anticipation is critical to your success!
– For every practice item manipulate the stem to
make each distractor become a correct answer.
Example
A 64yo male with thoracic complaints….
Historical and Physical features
EKG, Labs, X-rays, other…
A. Myocardial Infarction
B. Pericarditis
C. Pulmonary Embolism
D. Dissecting Thoracic Aortic Aneurysm
E. Somatic Dysfunction
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Example
A 64yo male with chest tightness….
Hx: HTN and Chol; PE: Carotid Bruits
ST Segment elevation (II, III & aVF); CK-MB
A. Myocardial Infarction
B. Pericarditis
C. Pulmonary Embolism
D. Dissecting Thoracic Aortic Aneurysm
E. Somatic Dysfunction
Example
A 64yo male with acute pleuritic pain….
Hx: Virchow’s Triad; PE: Sinus Tachycardia
EKG: S1Q3 3; CXR: hemidiaphragm elev
A. Myocardial Infarction
B. Pericarditis
C. Pulmonary Embolism
D. Dissecting Thoracic Aortic Aneurysm
E. Somatic Dysfunction
Why are Standardized Tests so hard?
Faculty-generated tests Standardized tests
Maximizing your SCORE
Test-Wiseness Test-Taking Skills
• Reading Accuracy
• Reading Fluency
• Guessing
• Changing Answers
• Test Blueprint
• Long-term Memory
• Transfer
• Self-Regulation
TEST
ANXIETY
PLANNING
for
Standardized
TestsScoring
Content
Skills
Timed
Guessing
Items
Standardized Tests - PLANNING
Test-Wise Test-Takers: First Step in Planning
7/28/2014
29
References 1. West DC et al. Critical Thinking in Graduate Medical Education.
JAMA. 2000;284(9):1105-1110
2. McGaghie WC, et al. What is the Impact of Commercial Test Preparation Courses on Medical Examination Performance? Teaching and Learning in Medicine. 2004;16(2):202-211.
3. Werner LS, Bull BS. The Effect of Three Commercial Coaching Courses on Step One USMLE Performance. Medical Education. 2003;37:527-531
4. Sefcik DJ, Prerost FJ, Arbet SE. Personality Types and Performance on Aptitude and Achievement Tests: Implications for Osteopathic Educators Journal of the American Osteopathic Association. 2009;109(6):296-301
5. Millman J, Bishop CH. An Analysis of Test-Wiseness Educational and Psychological Measurement. 1965;25(3):707-726
6. Evans W. Test Wiseness: An Examination of Cue-Using Strategies. Journal of Experimental Education. 1984;52(3):141-144
7. Dolly JP, Williams KS. Using Test-Taking Strategies to Maximize Multiple-Choice Test Scores. Educational and Psychological Measurement. 1986;46(3):619-625
8. Norman GR et al. Factors Underlying Performance on Written Tests of Knowledge. Medical Education. 1987;21:297-304
9. Wenghofer E et al. Doctor Scores on National Qualifying Examinations Predict Quality of Care in Future Practice. Medical Education 2009;43:1166-1173.
10. Baeten M, Kyndt E, Struyven K, Dochy F. Using Student-Centered Learning Environments to Stimulate Deep Approaches to Learning: Factors Encouraging or Discouraging Their Effectiveness. Educational Research Review 2010;5:243-260.
11. Skochelak SE. A Decade of Reports Calling for Change in Medical Education: What Do They Say? Academic Medicine 2010;85(9):S26-S33.
12. Prince M. Does Active Learning Work? A Review of the Research. Journal of Engineering Education. 2004;7:223-231.
13. Winne PH, Nesbit JC. The Psychology of Academic Achievement. Annual Review of Psychology 2010;61:653-678.
14. Laatsch L. Evaluation and Treatment of Students With Difficulties Passing the Step Examinations. Academic Medicine. 2009;84(5):677-683.
15. Jairam D, Kiewra KA. An Investigation of the SOAR Study Method. Journal of Advanced Academics 2009;20(4):602-629.
16. Michael J. Where's the Evidence that Active Learning Works? Advances in Physiological Education. 2006;30:159-167.
17. Light, Greg, Roy Cox, and Susanna Calkins. Learning and Teaching in Higher Education 2nd ed. London: SAGE, 2009.
18. Medina, J., Brain Rules. Seattle, WA: Pear Press, 2008.
19. Sefcik D, Bice G, Prerost F. How to Study for Standardized Tests. Jones & Bartlett Learning, 2013.
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